Systemic Amyloid A Protein Amyloidosis With Gastrointestinal Involvement.

Systemic amyloidosis is a multiorgan deposition of misfolded amyloid protein fibrils. The systemic amyloid A protein (AA) amyloidosis type predominantly involves the kidney and is mostly an under-recognized complication among persons who inject drugs. Gastrointestinal involvement in systemic AA amyloidosis that is associated with illicit drug use is uncommon. In this report, we present a case of a 40-year-old man with history of injection drug use, recurrent skin and soft-tissue infection, and renal AA amyloidosis that presented with painless bloody bowel movement, which initially resolved with conservative management. Upon further evaluation, the patient was found to have empyema that required antibiotic therapy and bilateral pleural drain. His hospital course was further complicated by multiple episodes of hematochezia requiring gastrointestinal consultation. Subsequent gastrointestinal biopsy revealed amyloid deposit.

A Rare Case of Complicated Emphysematous Pyelonephritis.

Emphysematous pyelonephritis is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue. The management of emphysematous pyelonephritis mainly depends on the extent of the disease. In this report, we present the case of a 48-year-old male who presented with left flank pain and imaging findings of left-sided emphysematous pyelonephritis with extensions of air into the pararenal space as well as a 5.6 cm bladder stone and severe right-sided hydroureteronephrosis. He initially received bilateral nephrostomy tubes, a left-sided perinephric draining tube, and intravenous antibiotics; however, his symptoms persisted. Ultimately, the patient underwent open cystolitholapaxy and left nephrectomy, with eventual resolution of symptoms.