Symptomatic primary (
amyloid light-chain or
AL) amyloidosis of the gastrointestinal (GI) tract is very rare. Most of the patients with symptomatic involvement of the GI tract present with altered motility, malabsorption, or
bleeding. We report a case of gastric and colonic
amyloidosis on anticoagulation presenting with massive upper and lower GI
bleeding. A 67-year-old lady known to have
multiple myeloma and
AL amyloidosis on
rivaroxaban presented with massive upper GI
bleeding. Esophagogastroduodenoscopy showed a mass lesion (3 × 7 cm) located along the greater curvature in the body/antrum with active
bleeding. Mucosal biopsies revealed
amyloid deposition. She underwent partial
gastrectomy and recovered well after surgery, and was discharged home on
rivaroxaban. The patient presented again 4 weeks after discharge with
bleeding per rectum, and a colonoscopy revealed a large mass in the proximal transverse colon with active
bleeding. Biopsy of the mass showed
amyloid deposition. At this point, the patient declined any further intervention.
Rivaroxaban was discontinued, the rectal
bleeding stopped, and she was discharged home with no further episodes of GI bleed.
Amyloidosis of the GI tract presenting with massive GI bleed is extremely rare and is thought to be related to small-vessel fragility due to
amyloid infiltration and impaired hemostasis caused by
factor X deficiency. Even though GI
bleeding with
amyloidosis is spontaneous, use of anticoagulation could activate such episodes in these patients. Caution should be exercised with the use of anticoagulation in patients with
amyloidosis involving the GI tract, and colonoscopy should be considered in patients with gastric
amyloidosis.