A patient diagnosed with esophageal amyloidosis based on a submucosal hematoma observed on hematemesis

Abstract

The patient was a 77-year-old female. She was brought to our hospital by ambulance with hematemesis. Upper gastrointestinal endoscopy revealed a submucosal hematoma in the thoracic/upper esophageal regions. A proton pump inhibitor was administered, but vomiting frequently occurred thereafter, showing exacerbation. Acute heart failure developed, and a catecholamine preparation was introduced, but there was no improvement, leading to a fatal outcome. Esophageal biopsy at the periphery of the submucosal hematoma showed amyloid deposition. Pathologically, AL-type amyloidosis was suggested. A urine sample was positive for Bence Jones protein, and cephalic CT revealed a punched-out lesion, leading to a diagnosis of multiple myeloma. Although symptoms of multiple myeloma include low back pain, anemia, and renal dysfunction, a submucosal hematoma may also become a diagnostic criterion.