of sputum and sputum culture positive for Myco- bacterium tuberculosis in Lowenstein media) and had been given isoniazid (300 mg/day), rifampi- cine (600 mg/day), ethambutol (1.5 g/day) and pyrazinamide (2 g/day) for 2 months, followed by isoniazid and rifampicine for 10 more months, until 2 months prior to his hospitalization. His condition rapidly deteriorated with the above mentioned symptoms apparent 2 months after cessation of antituberculosis therapy. Physical examination revealed a severely mal- nourished male with a temperature of 39 ; blood pressure 100/60 mmHg; and a heart rate of 96/ min. Abdominal examination revealed increased bowel sounds and slight abdominal tenderness. Laboratory studies disclosed: hemoglobin, 14.3 g/dL; WBC, 15,600/μL; platelets, 308,000/μL; ESR, 60 mm/h; CRP, 41.4 mg/dL (normal 0-5); total protein, 5.1 g/dL; and albumin, 2.7 g/dL. Other biochemical data was normal. Urinalysis revealed 4+ proteinuria with oval fat bodies in the sediment. Creatinine clearance was 93 mL/min and proteinuria was 9 g/d. Serum immunoglo- bulins were as follows: IgG, 168 mg/dL (normal 800- 1700); IgM, 8.95 mg/dL (normal 50-320); IgA, 10.2 mg/dL (normal 85-450); and, IgE, 28.7 IU/mL (normal 0-100). C3 complement was 54.3 mg/dL (normal 50-90). Anti-gliadine IgA and IgG were both negative. CD4/CD8 ratio, CD3, CD56 were normal and tuberculin skin test was positive (17 mm induration). Neutrophil function tests (chemotaxis, phagocytosis, oxidative burst) were within normal limits. Chest X-ray and ECG were normal. Cultures of blood and urine were negative. Numerous erythrocytes and leucocytes were seen in the stool specimen, but stool cultures for Salmonella, Shigella and Campylobacter were negative. Toxin A was negative in the stool. Se- rologies for HIV, HBV, HCV were negative. Anti- HSV, anti-EBV and anti-CMV IgM's were also negative. Thoracic CT revealed old fibrotic scars in the upper lobes of both lungs, suggesting healed tuberculosis. Abdominopelvic CT was normal. On radiologic examination of the small bowel, there was dilatation and increased mucosal thickness of valvula conniventes. Gastroduodenoscopy was normal; multiple biopsies were obtained and duo- denal aspiration was performed. Rectosigmoi- Yonsei Med J Vol. 46, No. 6, 2005 Aykut Ferhat Çelık, et al. doscopy was nondiagnostic. Histologic examina- tion of esophageal, duodenal, colon (Fig. 1) and gastric (Fig. 2) biopsies revealed extensive, sub- epithelial, Congo red positive amyloid deposition. Disappearance of these after adding KMnO4 suggested AA amyloidosis, also confirmed by im- munohistochemical staining. In addition, the four currently identified mutations of MEVF gene on exon 10, associated with familial Mediterranean fever (FMF) -which are M694V, M694I, M680I, V726A,- were negative. Ciprofloxacine (200 mg, bid, i.v.) and metroni- dazole (500 mg, bid, i.v.) were commenced. The patient's clinical condition started to improve within a few days and returned to normal at 3 weeks. The antibiotics were then discontinued and the patient was discharged. Two weeks later, Fig. 1. Massive amyloid deposition beneath the surface epithelium (Congo-red × 200). Fig. 2. Extensive amyloid deposition is visible among the crypts of the lamina propria and in the deep mucosa. (Congo-red × 200).