A case of recurrent gastric ulcer due to spontaneous destruction of hematoma caused by amyloidosis

Abstract

A 65-year-old man with liver cirrhosis due to HCV infection and receiving hemodialysis for chronic renal failure was admitted to our hospital due to sudden onset hematemesis. Endoscopic examination revealed a large submucosal hematoma on the antrum of the stomach. A repeat examination performed 24 hours later showed formation of an ulcerative lesion due to spontaneous rupture of the hematoma. Two months later, the patient showed melena and anemia associated with hemorrhage from the gastric ulcer due to rupture of the hematoma; similar events repeatedly occurred six times during the subsequent two years. Total gastrectomy was performed, and histological examination revealed amyloid protein deposition─identified by immunostaining as being derived from β2-microgloblin─in the muscularis mucosae and muscularis propria of the stomach. Gastric amyloidosis should be considered a candidate of cause of gastric ulcer in patients without H. pylori infection or NSAIDs intake.