Abstract
A 73-year-old woman who was diagnosed with rheumatoid arthritis 28 years earlier and had been on internal treatment with 5 mg/day of prednisolone presented to our emergency clinic because of abdominal pain and vomiting. After emergency admission, her blood pressure decreased on the next morning and her abdominal pain also became worse. Blood analysis showed increases in biliary enzymes and inflammatory reaction, a decrease in the platelet count, and an increase in blood FDP level. An abdominal CT scan revealed enlargement of the gallbladder and thickening of the gallbladder wall. She was diagnosed with septic shock and DIC associated with acute cholecystitis. Emergency cholecystectomy under laparotomy was performed. Macroscopic findings of the resected specimen included necrosis of the gallbladder mucosa and thickening of the gallbladder wall. There were no stones within the gallbladder. Histopathology disclosed transmural necrosis of the gallbladder wall and type AA amyloid deposits mainly within the vascular wall.
It was etiologically considered that AA amyloidosis secondary to rheumatoid arthritis might cause gangrenous cholecystitis. After the operation, respiratory condition and circulatory dynamics were unstable. Despite continuous treatments of septicemia and DIC, she did not respond to the treatments and died on the 42nd postoperative day.
