A case of (al) amyloidosis that occurred multiple intestinal perforation during paclitaxel chemotherapy

Abstract

We report the case of a 65-year-old woman who had been on dialysis because of renal failure resulting from light-chain associated (AL) amyloidosis and was treated with brachytherapy (Bt) for carcinoma of the left breast in 2007. The patient complained of abdominal pain on the 11^th day after the administration of the first dose of Paclitaxel, which was administered as adjuvant chemotherapy. Computed tomography (CT) scans showed free air, which led to the diagnosis of perforation peritonitis, and the patient underwent emergent surgery. Laparotomy revealed a perforation on the left side of the transverse colon. Therefore, the left half of the colon was resected, the anal stump was closed, the transverse colon was elevated, and a stoma was constructed. Histopathological examination showed no inflammatory or tumoral lesions but revealed eosinophilic deposits in the vascular walls of blood vessels ranging from submucosal arterioles and venules to medium-sized subserous arteries and veins. Congo red staining showed positive findings. These results showed that the perforation might have been caused by amyloid deposition, or by vascular rupture, hemorrhage, or circulatory failure due to Paclitaxel. After the operation, purulent discharge was found from the drain placed in the abdominal cavity, and contrast imaging for the visualization of the small intestine suggested recurrence of the digestive tract perforation. However, spontaneous closure of the perforation was achieved by conservative treatment, and the patient was discharged on the 36^th day after surgery.