NOT JUST ANOTHER DIARRHEA: A CASE OF SECONDARY AMYLOIDOSIS ASSOCIATED WITH LYMPHOMA. J. Chowdhury 1 , A. Gomez 1 ; 1 UCLA San Fernando Valley, Sylmar, CA (Tracking ID #76168) LEARNING OBJECTIVES: 1) Recognize lymphoma as a chronic inflammatory state that can be associated with secondary amyloidosis 2) Distinguish between primary and secondary amyloidosis. CASE INFORMATION: A 44 year old Hispanic male with non-Hodgkin's lymphoma, diagnosed and treated in Mexico with chemotherapy and radiation five years ago presents with five months of large volume, watery diarrhea. He had four to six episodes of blood-tinged diarrhea per day, with abdominal cramps, nausea and vomiting. The patient had anorexia with a twenty pound weight loss, orthopnea and bilateral lower extremity edema. His blood pressure was 60/palp, pulse 88, and he was afebrile. He had dullness to percussion and decreased breath sounds over the left lower lobe as well as 1+ pitting edema in BUE and 2+ pitting edema in the BLE. A CBC was normal, BUN 38, creatinine 1.3, PT 29.6, INR 2.47, PTT 47, albumin 1.4, AST 10, ALT 13, alkaline phosphatase 153, total bili <0.1, LDH 762. Urinalysis showed small blood, 3+ proteinuria, 2 rbc's and 3 wbc's. CXR showed a left-sided pleural effusion. The patient was admitted to the ICU and started on IV steroids and pressors. Thoracentesis revealed a transudate with many lymphocytes, but no malignant cells. CT scans revealed a mass in the left upper lobe of the lung and left hemithorax volume loss, colon dilation to 6 cm and small bowel dilation to 3 cm. Biopsy of the lung mass revealed Hodgkin's lymphoma. Bone marrow biopsy was positive for both crystal violet and Congo Red, suggesting amyloidosis. Rectal biopsy showed friable mucosa and revealed apple green birefringency when viewed with Congo Red stain, confirming the diagnosis of gastrointestinal amyloidosis. Unfortunately he succumbed to the disease a week later while on steroids and chemotherapy. IMPLICATIONS/DISCUSSION: Both primary and secondary amyloidosis present in a variety of ways, including heavy proteinuria, edema, hepatosplenomegaly, hematochezia, congestive heart failure, and carpal tunnel syndrome. Secondary, or AA, amyloidosis occurs in chronic inflammatory states, such as rheumatoid arthritis, inflammatory bowel disease, or osteomyelitis. However, reports of an association with lymphoma are rare. Obtaining a good past history for chronic inflammation is nevertheless important when diagnosing AA amyloidosis. The only disease linked to primary, or AL, amyloidosis is multiple myeloma. Once the diagnosis of amyloidosis is made from tissue biopsy, the distinction between primary and secondary amyloidosis is made based on the presence of a chronic inflammatory state in secondary amyloidosis or the presence of certain paraproteins, found in about 90% of primary amyloidosis. We diagnosed this patient as secondary amyloidosis based on his history of lymphoma.