CATASTROPHIC HAEMORRHAGE FROM THE BLADDER DUE TO UNRECOGNISED SECONDARY AMYLOIDOSIS

SUMMARY We report the cases of a 41‐year‐old man, who died of severe and intractable hzmorrhage from the urinary bladder, and of a 55‐year‐old woman in whom such hzmorrhage ushered fatal urzmia. He had suffered from severe ankylosing spondylitis with involvement of proximal limb‐joints for 14 years, and she from severe rheumatoid disease for 20 years with episodes superimposed pyogenic arthritis during the last 3 months. Both had widespread secondary amyloidosis, unrecognised in life, with severe involvement of the blood‐vessels of the vesical submucosa‐the source of the hzmorrhage‐and of the kidneys. Factors probably contributing to the initiation of bleeding were severe hypertension in the man, septicremia ( Streptococcus pyogenes ) and prolonged hypotension in the woman, and a considerable degree of renal failure both. It is suggested that—whenever exploratory cystotomy fails to reveal the cause of continuing bleeding from the bladder—a sample of the vesical wall should be submitted to microscopy.