We present the case of a 22-year-old woman with Crohn’s disease who developed nephrotic-range proteinuria following Ustekinumab therapy. This is the first case in the literature. The patient started to have massive bilateral lower limb swellings with proteinuria. Renal biopsy revealed focal segmental glomerulosclerosis. Ustekinumab was held which led to complete resolution of the symptoms and proteinuria. This case highlights the potential nephrotoxic effects of ustekinumab and underscores the importance of close monitoring for renal complications in patients with inflammatory bowel disease receiving biologic therapy.

Introduction: This study aims to explore the reno-protective effect of Curcumin in focal and segmental glomerulosclerosis (FSGS) in Murine models, a common chronic glomerulopathy that leads to end stage renal disease. Methods: Adult Wistar rats were used in this experiment. One group was treated with intravenous Adriamycin (ADR) injection to induce FSGS similar to that seen in humans and a second group was co-administered ADR and Curcumin (ADR-CUR). Saline treated rats served as controls. Renal injury was assessed by measuring the levels of serum creatinine, blood urea nitrogen (BUN), triglyceride and urinary protein. The homogenates of renal cortex were used to estimate the renal content of the inflammatory marker, tumor necrosis factor-a (TNF-a); oxidative stress marker, Malonaldehyde (MDA); and two anti-oxidants superoxide dismutase (SOD) and reduced glutathione (GSH). In addition, the rat kidneys were harvested by ends of week-8 and week-12 and examined for histological abnormalities. Results: The ADR-treated rats showed biochemical and histological evidence of FSGS, in the form of proteinuria, elevated serum creatinine, BUN and triglycerides, elevated renal TNF-a and MDA, and segmental glomerulosclerosis. The ADR-CUR treated rats showed significant correction of all these variables. Co-administration with Curcumin resulted in improvement of the proteinuria, serum creatinine, BUN and triglyceride. The renal tissue levels of anti-oxidants SOD and GSH increased and that of TNF-a and MDA decreased and the histology revealed reduction in the extent of segmental glomerulosclerosis. The FSGS associated renal damage was notably antagonized by curcumin treatment. Conclusion: Our findings confirm the reno-protective effects of Curcumin as a potential therapeutic agent in protection against the progression of FSGS and indicate that it is mitigated by inhibition of oxidant injury and inflammation and also by promotion of antioxidants. Curcumin ameliorated the ADR-induced FSGS in murine models. It may be a promising compound in the treatment of FSGS in human subjects. More human studies are needed to further elucidate its effects in FSGS.

Postinfectious glomerulonephritis (PIGN) is one of the most common causes of acute kidney injury in children worldwide. In most cases, there is complete clinical and morphological recovery. Rarely, patients present with persistent abnormal renal function for a few months or years after an episode of PIGN, some even progressing to renal failure. Here, we describe a case of an 11-year-old boy with biopsy-diagnosed PIGN, demonstrating persistent proteinuria, hematuria, and hypertension even 1 year after being treated for PIGN. A second follow-up biopsy showed chronic glomerulopathy in the form of focal and segmental glomerulosclerosis (FSGS) and mesangial hypercellularity. The journey of this patient from PIGN to FSGS is detailed in this case report.

Background:Defining immunoglobulin M (IgM) nephropathy as a discrete clinical disorder remains controversial, with limited documentation in Saudi Arabian patients. Aim:This study analyzes the clinical and pathological features, as well as the prognosis, of IgM nephropathy in the Saudi population. Methods:This study is conducted as a retrospective descriptive study at the nephrology unit of King Saud University Medical City in Riyadh. The study included individuals with biopsy-proven IgM nephropathy from 2016 to 2024. Stringent diagnostic criteria were employed, focusing on immunofluorescence positivity (IgM 1+ to 3+). Clinical data were collected from a kidney biopsy registry from the pathology department at King Saud University, and renal pathology was evaluated by a single expert renal pathologist for various features, including mesangial cell proliferation and glomerulosclerosis. Results:We analyzed a total of 15 patients with IgM nephropathy (n = 15), with a median age at diagnosis of 4 years (IQR: 2-8) and a male predominance (80%). Patients were categorized into early childhood onset (<4 years, 46.7%) and late childhood onset (≥4 years, 53.3%). Common manifestations included nephrotic syndrome (93.3%) and generalized body swelling (66.7%), with lower limb edema reported in all patients (100%). Nephrotic-range proteinuria was present in 93.3%, with preserved renal function (median eGFR: 158 mL/min/1.73m²). Biopsy results for nine patients revealed mesangial proliferation in 66.7%. The overall relapse rate was 93.3%, with early-onset patients exhibiting higher rates of steroid resistance and more frequent relapses. Conclusion:This study enhances the understanding of IgM nephropathy in Saudi Arabia, indicating that early onset may be associated with a more aggressive disease course and higher relapse rates, highlighting the need for early identification of high-risk patients. Additionally, the use of rituximab in refractory cases may present a promising option for further evaluation.

Diabetes Mellitus during wound healing alters macrophage recruitment, leading to delayed healing. The present study focuses on impact of camel milk peptide (CMP) on macrophage plasticity during their recruitment during wound healing stages. The Swiss albino rats were distributed into three groups: a normal wounded group (control), a wounded diabetic group, and a wounded diabetic group treated with CMP daily. The diabetic rats showed a significantly compromised level of monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein (MIP-1α) relative gene expression, anti-CD31, anti-Mac-3, and anti-CD68 staining than the control group. Macrophages were considerably depleted in diabetic group animals upon initiating the inflammatory phase, while the protein significantly reversed the same. Also, there was marked increase in pathogenic bacterial growth at the wound sites of diabetic rats. On the contrary, in CMP-diabetic rats, levels of pathogenic bacteria were comparable to normal control animals. Diabetic rats demonstrated a reduction in matrix metalloproteinase (MMP-9 and MMP-13) expression while increased TNF-α levels compared to control rats. In addition, they also showed significantly reduced expression of VEGF and fibroblast growth factors (FGF) genes and IL-10 during the proliferation phase. However, all these parameters exhibited a considerably reversed trend in the CMP treated diabetic rats. Hence, CMP-treated diabetic rats demonstrated a transition to the M2 phenotype, highlighting macrophage recruitment's critical role in healing of wounds in hyperglycemic rats.

Gastrointestinal basidiobolomycosis (GIB) is a very rare fungal infection of the gastrointestinal tract and is therefore not commonly suspected in patients with signs and symptoms of gastrointestinal disease. If not diagnosed and treated on time, GIB can become aggressive and cause significant lifelong morbidities. Very few cases have been reported in literature. We, herein, describe one such case which was missed in spite of the patient's timely visit to the hospital. This is a case of a 15-year-old girl who on initial evaluation was mistreated as acute appendicitis. Subsequently, she was suspected to have inflammatory bowel disease (IBD) or a gastrointestinal lymphoma. Her condition rapidly deteriorated and she went on to develop an intestinal perforation for which she had to undergo subtotal colectomy. Only upon histopathological evaluation, she was diagnosed to have GIB. Since it is so uncommon, its clinical presentation can be misinterpreted from the outset, as it was in our case, leading to initial mismanagement, delayed diagnosis and secondary complications.

Podocytes are epithelial cells lining the outer surface of the renal glomerular capillaries and they play a pivotal role in maintaining the structural and functional integrity of the glomerular filtration barrier. Podocytes react to injury in various ways and any injury to these highly specialized cells can progress to podocyte dysfunction, resulting in a group of proteinuric renal diseases called podocytopathies. Podocytopathies include a wide spectrum of primary and secondary kidney diseases, including minimal change disease, diffuse mesangial sclerosis, focal segmental glomerulosclerosis, collapsing glomerulopathy, diabetic, membranous and lupus nephropathies. Etiologically, they can be idiopathic, genetic or secondary to infections and drugs, metabolic diseases, hemodynamic factors or associated with various immune and non-immune systemic diseases. This manuscript provides a basic understanding of podocyte structure, causes of podocyte injury, response to the injury and the subsequent progression to podocytopathies. The pathogenesis of these diseases is set around podocytes. The clinical and morphological manifestations, the commonality and heterogeneity of these podocytopathies are also discussed. As our knowledge of podocyte biology improves, so will our treatment avenues with a more podocyte-centric personalized approach.

Primary focal segmental glomerulosclerosis (FSGS) is a type of chronic renal disease that commonly progresses to renal failure as the treatments are not particularly effective. Glomerular podocyte injury and loss are pivotal to the pathogenesis of FSGS. This study aims to explore the glomerular immunohistochemistry stain expression of Wilms tumor-1 (WT-1) (podocyte-specific protein), transforming growth factor beta (TGF-β) (cytokine protein), vascular endothelial growth factor (VEGF) (angiogenic protein), and endothelin-1 (ET-1) (profibrotic growth factor), in rats with adriamycin nephropathy, which represents the murine model of human FSGS. By the end of 8 and 12 weeks, the kidneys of adriamycin-treated rats and control rats were harvested and the histomorphology was studied. Both 8- and 12-week test groups developed proteinuria, and hypoalbuminemia and showed FSGS on hematoxylin and eosin-stained slides. The renal tissue samples were also treated with immunostains for WT-1, TGF-β, VEGF, and ET-1. The glomeruli in all the FSGS kidneys showed loss of WT-1 expression with a concomitant notable increased expression of TGF-β, VEGF, and ET-1 immunostains. These results demonstrate that as FSGS evolves, the WT-1-expressing podocytes are lost and it correlates inversely with the overexpression of TGF-β, VEGF, and ET-1, suggesting that during the pathogenesis of FSGS, podocyte damage triggers the activation of these proteins. The findings in the current study echo the theory hypothesized in world literature that TGF-β, VEGF, and ET-1 play an integral part in the evolution of FSGS. More research is needed to further detail the pathogenic role of these proteins as it may open routes to more targeted and effective treatment modalities.

Granuloma faciale (GF) is a rare benign chronic inflammatory dermatologic disease which is characterized by facial lesions. The diagnosis is mainly based on clinical and histopathology findings. It may be resistant to treatments and prone to relapse. Different treatment modalities include corticosteroid therapy, tacrolimus, cryotherapy and surgical methods. We report a case of GF in a patient with Remitting seronegative symmetric synovitis with pitting edema (RS3PE). A male patient with RS3PE presented with reddish brown soft nodules on and over lateral aspects of his nose and adjacent areas on his face which were diagnosed histologically as GF. He was treated with prednisolone, methotrexate and clobetasol propionate cream successfully without recurrence. To the best of our knowledge this is the first case report of GF occurring in a patient with RS3PE.

BACKGROUND Colorectal cancer is one of the most common cancers in men and women worldwide. There are several studies showing an association between chronic schistosomiasis infection and colorectal cancer. CASE REPORT A 53-year-old woman presented with recurrent metastatic colon cancer involving the peritoneum and bilateral adnexa. The patient then underwent exploratory laparotomy that involved abdominal wall deposit resection, omentectomy, redo left hemicolectomy, peritonectomy, diaphragmatic stripping, and total abdominal hysterectomy with bilateral salpingectomy-oophorectomy, as well as hyperthermic intraperitoneal chemotherapy (HIPEC). She also underwent adjuvant chemotherapy, but on her 6th cycle, the patient suffered intolerable anal pain, diarrhea, and rectal bleeding. Her colonoscopy showed extended circumferential inflammation with loses of vascular pattern and a few rectal ulcers going up to the anastomosis site. Biopsy revealed Schistosoma mansoni eggs and marked ischemic changes. She was then managed with a single dose of Praziquantel. CONCLUSIONS Colorectal schistosomiasis infection is a rare cause of such common presentations especially in postoperative settings in a patient with recurrent metastatic colon cancer. The use of multimodality investigations and high clinical suspicion were needed for the diagnosis and to exclude other common etiologies.

Objectives: To assess and age stratify the types and frequencies of endometrial pathologies in Saudi women with abnormal uterine bleeding (AUB) that underwent endometrial biopsies, at our hospital over a 13-year period. Methods: In a retrospective study, from 2006 to 2018, all endometrial biopsies from Saudi women with AUB, reported at the laboratory of King Saud University-Medical City, Riyadh, Saudi Arabia, were revisited and analyzed. The women were categorized into <40, between 40-55 and >55 years of age. Results: We analyzed 6458 biopsies. In <40 and 40-55 years’ groups cyclical endometrium was most common followed by endometrial polyps and disordered proliferative endometrium. In the >55 years’ group, atrophic endometrium was most common followed by endometrial polyps. The hyperplasias and malignancies together accounted for 7.2% of the study, majority in the >55 years’ group. Simple hyperplasia without atypia was the most common (3.9%), followed by malignancies (1.9%), complex atypical hyperplasia (0.7%), complex hyperplasia without atypia (0.4%), and simple atypical hyperplasia (0.3%). Conclusion: Awareness of the probable spectrum of endometrial histopathologies in the various ages is useful in guiding management. Endometrial biopsies are valuable in early detection of precancerous and cancerous endometrial lesions especially in women over 40 years.

BackgroundThe prognostic impact of neoadjuvant chemotherapy (NAC) on the receptor expression status in patients with locally advanced breast cancer (LABC) is still not fully understood. We aimed to evaluate the changes in hormone (estrogen and progesterone) receptor (HR) and human epidermal growth factor receptor 2 (HER2) status post-NAC and their correlation with survival.MethodsPatients with LABC who have received NAC between 2008 and 2015 and have been followed up till December 2019 at the Oncology Center, King Saud University, KSA were analyzed retrospectively. biomarker analysis of ER, PR & HER2 were done using immunohistochemistry (IHC) and Fluorescent in situ hybridization.ResultsNinety-one patients fulfilled the inclusion criteria. HR status changed in 21(23.1%) patients, with a significant difference between patients with stable receptors and those with any receptor conversion; p = 0.000. Five (5.5%) initially HER2 negative tumors became HER2 positive and 10 (11%) initially HER2 positive tumors became HER2 negative after NAC. The difference in HER2 expression level before and after NAC was not statistically significant (p = 0.302). Univariate analysis relating patients' characteristics and 10-years disease-free survival (DFS) showed only significant correlations with the expressions of ER, PR, and any receptor conversion, (ER and/or PR) p< 0.001, p< 0.001, and p = 0.001; respectively. In the univariate analysis, none of the clinicopathological features showed a significant correlation with the OS except for the molecular subtypes P<0.001.ConclusionsPatients with LABC have significant changes in the ER and PR receptor status following NAC. Post-NAC expressions change of ER and PR (ER and/or PR) are correlated to DFS. Retesting of the hormone receptors should be considered after NAC in Saudi patients with LABC.

BACKGROUND:Cisplatin is a major anti-cancer drug commonly used in the treatment of various cancers; nevertheless, the associated hepatotoxicity has limited its clinical application. The aim of this investigation is to test the impact of betaine supplementation on cisplatin-induced hepatotoxicity.METHODS:Animals were allocated into four groups; normal control group (control betaine group (250 mg/kg/day, po for twenty six days), cisplatin group (single injection of 7 mg/kg, ip) and betaine + cisplatin group (received betaine for twenty one days before cisplatin injection and daily after cisplatin for five days).RESULTS:Cisplatin-induced liver injury was confirmed by increased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Cisplatin elevated lipid peroxides, and reduced the concentrations of reduced glutathione (GSH), glutathione peroxidase (GSH-Px), catalase and superoxide dismutase (SOD) in hepatic tissues. Cisplatin increased the inflammatory mediators; nitrite and tumor necrosis factor-α (TNF- α) in hepatic tissues. Increased gene expressions of the apoptotic marker, caspase-3 and nuclear factor-kappa B (NF-κB) were observed in hepatic tissues of cisplatin-treated rats. All these changes were further confirmed by histopathological findings in cisplatin group. Pre-treatment with betaine reduced serum aminotransferases (ALT and AST), and lowered hepatic concentrations of lipid peroxides, nitrite and TNF-α while increased SOD, GSH, catalase, and GSH-Px concentrations. Moreover, the histological and immunohistochemical changes were improved.CONCLUSION:The suppression of NF-κβ-mediated inflammation, oxidative stress, and caspase-3 induced apoptosis are possible mechanisms to the observed hepatoprotective effect of betaine.

BACKGROUND: Recent international reports have shown significant changes in the incidence of different glomerular diseases. OBJECTIVE: Examine temporal and demographic trends of biopsydiagnosed glomerular diseases in the adult population of Saudi Arabia over the last two decades. DESIGN: Medical record review. SETTINGS: Four tertiary medical centers in Saudi Arabia. PATIENTS AND METHODS: We identified all patients that underwent native kidney biopsy between 1998 and 2017. MAIN OUTCOME MEASURES: The frequency and the disease trends in four biopsy eras (1998-2002, 2003-2007, 2008-2011, and 2012-2017) for different glomerular diseases. SAMPLE SIZE AND CHARACTERISTICS: 1070 patients, 18-65 years of age; 54.1% female. RESULTS: Of 1760 patients who underwent native kidney biopsies, 1070 met inclusion criteria. Focal segmental glomerulosclerosis was the most common biopsy-diagnosed disease, with comparable frequencies over the four eras (23.6%, 19.8%, 24.1%, and 17.1, respectively [P value for trend=.07]). The frequency of immunoglobulin A nephropathy increased progressively. The incidence of membranoproliferative glomerulonephritis declined significantly. Among the secondary types of glomerular diseases, systemic lupus erythematosus-associated lupus nephritis was the most common, followed by diabetic nephropathy. The prevalence of diabetic nephropathy increased from 1.4% in the first era to 10.2% in the last one. CONCLUSIONS: Trends in biopsy-diagnosed glomerular disease have changed. While focal segmental glomerulosclerosis remains the most common glomerular disease, there has been a significant rise in the prevalence of immunoglobulin A nephropathy and diabetic nephropathy. In contrast, membranoproliferative glomerulonephritis has declined. LIMITATION: Retrospective methodologies are vulnerable to lost data. CONFLICT OF INTEREST: None.

Objectives: The Papanicolaou screening test (Pap smears) is performed to preemptively identify and treat cervical cancer. This study aims to estimate the frequency of positive cervical Pap smears during the last 10 years in our institution and compare with world literature. Design: Retrospective chart review Setting: Tertiary hospital in Riyadh, Saudi Arabia Subjects: Cervical smears of Saudi women from 2004-2014 were reviewed, abnormal smears identified and correlated with histopathology. The prevalence, mean age and standard deviation for each type of abnormal smear was calculated. Non-Saudi women were excluded from this study. The obtained data was compared with national and international studies. Interventions: None Main outcome measure and results: The number of cervical smears reported as abnormal was low (1% in 10 years). About half the abnormal smears were atypical cells of undetermined significance (47.6%), followed by low-grade squamous intraepithelial lesion (23.2%), high-grade squamous intraepithelial lesion (8.5%), squamous cell carcinoma (SCC, 6.1%), atypical glandular cells favor neoplasia (6.1%), adenocarcinoma (AC, 3.3%) and others (5.3%). The mean ages of SCC and AC were 57 and 70 years, respectively. Conclusion: The proportion of abnormal cervical Pap smears in Saudi Arabian women is low and the women positive for squamous carcinoma are in the relatively older age group. We recommend establishing human papilloma virus (HPV)-DNA testing at all our major centers to guide management. Despite low incidence of cervical carcinoma, adding HPV vaccine to the mandatory list of vaccinations in Saudi Arabia will be useful.

BACKGROUND Progranulin is an adipokine, encoded by the progranulin (GRN) gene. Progranulin is expressed in atherosclerosis, but its effects in cardiac ischemia and reperfusion injury are unknown. Therefore, this study aimed to investigate the effects of progranulin in a rat model of acute myocardial ischemia/reperfusion (MI/R) injury in vivo. MATERIAL AND METHODS The model of acute MI/R injury was established in male Wistar rats by ligation of the left anterior descending (LAD) coronary artery for 30 minutes and reperfusion for 60 minutes. Before modeling, one group was treated with progranulin (0.03 µg/kg), and one group was treated with the P13K/Akt inhibitor, LY294002 (3 mg/kg). Left ventricular function (LV) was monitored, including the LV systolic pressure (LVSP), LV end-diastolic pressure (LVEDP), and changes in LV pressure. At the end of the study, blood and myocardial tissue were examined. Cardiac biochemical markers, histopathology, gene expression, and apoptosis were analyzed. RESULTS Progranulin improved cardiac function following acute MI/R injury and significantly improved recovery of cardiac contractility and LVSP. Progranulin significantly reduced myocyte apoptosis, inflammation, and tissue edema, and was highly expressed in cardiac tissue following MI/R injury. The cardioprotective effect of progranulin was reduced by blocking the P13K/Akt signaling pathway. CONCLUSIONS In the rat model of acute MI/R injury, progranulin had a protective effect on cardiac function and morphology, associated with activation of the P13K/Akt signaling pathway. The mechanisms of the anti-apoptotic, anti-inflammatory, and inotropic effects of progranulin in the setting of acute MI/R injury require further in vivo studies.

Objectives: To examined the short and long-term outcome of class II lupus nephritis (LN). Methods: This retrospective study included patients with class II LN at their first renal biopsy between January 1996 and December 2016 in King Khaled University Hospital, Riyadh, Saudi Arabia. The rate of complete remission, worsening renal function, and histological transformation in the second biopsy were examined. Results: The study included 32 female patients with class II LN. The most frequent presentation (62.5% of patients) was hematuria with subnephrotic range proteinuria. The clinical presentation included acute kidney injury in 22% of patients, and 9.4% had nephrotic range proteinuria. Management with steroid monotherapy in 25 patients resulted in complete remission for 92% of these patients at 6 months. After a median follow up of 8 years, 2 patients had a doubling of their serum creatinine. During the follow up 17 patients (53%) needed a second biopsy, which revealed transformation to other classes (65%). Conclusions: Daily steroid monotherapy may be an appropriate first-line treatment for class II LN that presents with subnephrotic range proteinuria and normal kidney function. Patients with acute kidney injury and/or nephrotic range proteinuria may warrant more aggressive immunosuppressive regimens.

The most common location of small cell neuro endocrine tumor (NET)is pulmonary, while the overall incidence of extra pulmonary NET is less observed. The extra pulmonary sites include the salivary glands, sinuses, thyroid, larynx, trachea, pleura, thymus, gastrointestinal tract, genitourinary tract, ovary, uterus, cervix, brain, lymph nodes, skin and eyelids.1 Non-ocular NET has been reported in various anatomic locations; however, primary orbital NET is uncommon, and majority of cases are metastatic.2 The orbit has been reported to be involved by NET in only 4-5% of all orbital metastatic cases.3 NET of the eyelid is a rare entity that has not been reported extensively in the ophthalmic literature.4 In this case report we describe a case of an aggressive neglected NET involving the left eyelids and anterior orbit. The case, was diagnosed based on histopathological features and immuno histochemical staining, however the origin of the tumor remained debatable.

Aim: Focal segmental glomerulosclerosis (FSGS) is a common progressive chronic renal disease. Podocyte injury and loss are the postulated pivotal events that trigger FSGS. In this study, the authors aim to examine the evolution of FSGS in murine models histologically, ultrastructurally and immunohistochemically with special emphasis on podocytes and parietal epithelial cells (PECs). Material and methods: FSGS resembling primary FSGS in humans was initiated in Wistar rats using intravenous Adriamycin injections. Blood and urine analysis were performed at 0, 8, and 12weeks. Both the control kidneys and the test kidneys were harvested at 8 and 12weeks, examined histologically and ultrastructurally and the findings correlated with the glomerular expression of immunostains specific for podocytes (WT-1) and for activated PECs (CD44). Results: FSGS developed in both 8 and 12 weeks test groups showing progressive proteinuria, podocytopathy and segmental glomerular scarring. There was a decrease in the glomerular expression of WT-1 with a concurrent increase in the glomerular expression of CD44, indicating podocyte loss with synchronous increase in activated PECs. The evolving FSGS correlated negatively with podocytes and positively with activated PECs. Conclusion: Our study shows that with podocyte injury there is podocyte effacement and loss, proteinuria, glomerular segmental adhesion and scarring, all culminating in FSGS. In addition, there is activation, hyperplasia and hypertrophy of PECs. This demonstrates that both podocyte loss and PEC activation promote FSGS. Our findings are consistent with recent investigations. More studies are required to further understand the role of these cells in the evolution of FSGS and subsequently introduce new targeted treatment modalities.

Angiosarcomas are aggressive and highly malignant tumors of endothelial cells, occurring mainly in the skin or superficial soft tissue of the head, neck and the breast. Primary angiosarcoma of the small intestine is extremely rare and very few cases have been reported in literature. We herein describe a case of primary duodenal epithelioid angiosarcoma with metastasis to the abdominal lymph nodes, lumbar vertebra, sacrum and iliac crest, in a 63-year-old gentleman. On initial evaluation, the clinical findings appeared suspicious of multiple myeloma. The patient was subsequently diagnosed as duodenal angiosarcoma based on radiology, endoscopy, histopathology and immunohistochemistry findings. Awareness of this aggressive and rapidly progressive entity is important. Due to its rarity, its clinical presentation can be misinterpreted at the outset, as it was in our case, leading to delayed diagnosis and management. To the best of our knowledge, this is the first report of primary angiosarcoma of the small intestine from the Middle East.