Intestinal pseudo-obstructive paralytic ileus and colonic bleeding due to myeloma-related (AL) amyloidosis

An autopsy case of a 57-year-old man with multiple myeloma (IgA lambda light chain) who developed chronic intestinal pseudo-obstruction and bleeding associated with gastrointestinal amyloidosis over three and a half years is reported Nine doses of cyclic therapy with VMCP (vincristine, melphalan, cyclophosphamide and prednisone) put the patient into partial remission. This was followed by maintenance therapy with MP (melphalan and prednisone) but levels of Bence Jones protein increased progressively. Subsequently, combination therapy of both alpha-interferon (αIFN) with VP (vincristine and prednisone) caused a decrease in Bence Jones protein. After 2 years, scrota1 tongue, abdominal distention and constipation appeared. A rectal biopsy was positive for amyloidosis. Gradually, paralytic ileus developed due to both extensive amyloid deposition in the digestive tract and a neurologic disorder as a side effect of the vincristine treatment. Six months after biopsy bleeding from multiple colonic ulcers associat...