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Heart was the key to the diagnosis
  1. Khawaja Junaid Akhtar1,
  2. Tina Maheswaran1,
  3. Christopher Watters1,2
  1. 1 Gastroenterology, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
  2. 2 Gastroenterology, Whiston Hospital, Prescot, UK
  1. Correspondence to Dr Khawaja Junaid Akhtar, Gastroenterology, Countess of Chester Hospital, Chester CH2 1UL, UK; khawajajunaid13{at}

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We present the case of a man in his 70s who was referred to gastroenterology with several months’ history of offensive smelling loose stools and weight loss. He underwent a standard panel of initial investigations including colonoscopy for his chronic diarrhoea. Colonoscopy was reported as normal and the results of the rest of his screening panel were unremarkable. As his symptoms persisted, lower GI endoscopy was repeated. This showed a few scattered diverticula and some possible left colonic mucosal congestion, but biopsies were reported as within normal limits (see figure 1).

Figure 1

H&E stain of colonic biopsy.

Concurrently, the patient started developing exertional breathlessness. Blood tests did not reveal any …

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  • Contributors TM assessed the patient in clinic, diagnosed with GI amyloidosis and consented the patient for this publication. KJA has written the manuscript, liaised with relevant specialities, presented in local medical unit meeting and submitted for publication. CW has supervised and contributed to writing the manuscript. Images have been contributed by histopathology and cardiology (echocardiography) departments at Countess of Chester hospital. KJA and TM are responsible for the overall content as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.