Primary localized ileal amyloidosis with chronic ileitis: a case report with review of literature

Amyloidosis is a rare condition where fibrillar proteins and abnormal, soluble peptides accumulate throughout the body’s organs. Gastrointestinal symptoms secondary to amyloid deposition vary widely and may be confused with other common small intestine diseases, making the diagnosis challenging. Our case is a 63-year-old male with a past medical history of smoking who showed up in the ED with 5 months of diffuse abdominal pain referred to the back. Pelvis-abdominal ultrasound showed bilateral acute pyelonephritis. A colonoscopy revealed large multiple ileal ulcers about 10 cm from the ileocecal valve with a wide base. Pathology biopsies revealed ileal amyloidosis and chronic ileitis with superficial erosions. The patient has been diagnosed with primary localized ileal AL amyloidosis. The patient has finally been referred for surgical resection. We want to raise awareness of ileal amyloidosis and emphasize the importance of considering uncommon etiologies of small intestine pathology in patients presenting with chronic diarrhea, malabsorption, abdominal pain, and weight loss. Finally, patients with small intestine amyloid disease progressing rapidly and failing to respond to non-surgical treatment should be considered for surgical resection.