Periorbital Ecchymosis With Haemoperitonuem: A Case of Amyloidosis

Amyloidosis is a metabolic storage disorder that results from the deposition of insoluble fibrillar or aberrantly folded proteins in various tissues. It can sometimes present with spontaneous haemorrhage, which in some cases could be life-threatening. Spontaneous intraperitoneal haemorrhage has previously been reported in amyloidosis, but it is extremely rare. We present the case of a patient in her late 60s with diabetes and systemic hypertension, who presented with ecchymosis of both the upper and lower limbs and bilateral periorbital area and a collection in the paracolic gutter. Further investigation confirmed that the retroperitoneal collection was a hematoma. On evaluating the aetiology, the diagnosis of amyloidosis was confirmed via Congo red staining of the abdominal fat pad and bone marrow biopsy, demonstrating characteristic apple-green birefringence under polarised light. The patient was treated conservatively for the hematoma and discharged in a stable condition. This case highlights the rare occurrence of spontaneous intraperitoneal haemorrhage in amyloidosis and emphasises the importance of considering this diagnosis in patients with unexplained hematomas.