Persistent Multiple Colonic Ulcers and Repeated Acute Bloody Diarrhea in an Elderly Patient with Transthyretin Amyloidosis: A Case Report

The clinical gastrointestinal manifestations of transthyretin amyloidosis (ATTR amyloidosis) are usually non-specific, and colonic bleeding or ulcers are unusual. Here, we report the case of an elderly Japanese man with ATTR amyloidosis who presented with rare gastrointestinal symptoms. An 84-year-old Japanese man was referred to our hospital because of anemia and positive fecal occult blood test results. Endoscopic examination revealed multiple small colonic erosions and/or ulcers; however, the cause remained unknown. The patient repeatedly visited our hospital for one year because of acute bloody diarrhea, anemia, and multiple persistent colonic ulcers. His symptoms improved after symptomatic treatment. The most recent gastric biopsy revealed ATTR amyloidosis, which was retrospectively detected in colon, stomach, and gallbladder specimens obtained six months, six years, and 12 years earlier, respectively. Therefore, ATTR amyloidosis should be considered in the differential diagnosis of colon-related anemia.