04 Nov

Amyloidosis and Pleural Disease

Amyloidosis and Pleural DiseaseThe reported prevalence of pulmonary involvement in patients with systemic amyloidosis ranges from 30 percent to 92 percent. Autopsy series have traditionally classified patterns of pulmonary involvement as being alveolar, tracheobronchial, and/or vascular in nature. Most series have not described histologic evidence for pleural disease with amyloidosis. Indeed, there have been only rare case reports describing such involvement. The paucity of descriptions of pleural disease associated with systemic amyloidosis is likely due to not considering this diagnosis in patients presenting with pleural effusions and multiorgan disease. In addition, biopsy specimens require staining with Congo red and/or crystal violet to detect amyloid deposition. Therefore, it is likely that the incidence of pleural involvement in patients with systemic amyloidosis in underestimated in the literature. buy ampicillin
We describe five patients with systemic amyloidosis and associated pleural effusions. The presence of pleural amyloidosis was established by percutaneous needle biopsy of the pleura in all five patients. In three of the five patients, percutaneous pleural biopsy was the initial diagnostic procedure to establish the presence of systemic amyloidosis. Clinical features of five previous case reports describing amyloidosis and pleural disease, along with the five patients whose cases are reported herein, are summarized in Table 1.

Table 1—Clinical Features of Ten Patients with Amyloidosis and Pleural Disease 

Pktient Age, sex Effusion Nature of Effusion Diagnosis by Cope Needle OtherBiopsies Cause of Amyloid Cause of Effusion
Case Source Year R L
1 MGH Case 48-1977 1977 58/M + + E N Alveolar-septal Primary Idiopathic
2 Vilaseca et al 1981 16/M + T Y Lymph node, thyroid Secondary to cystic fibrosis Nephroticsyndrome
3 Graham and Ahmad 1987 53/M Unspecified E N Lung biopsy N/A Idiopathic
4 Knapp et al Case 1 1988 67/F + E Y Rectal, breast Primary with plasma cell dyscrasia Idiopathic
5 Knapp et al Case 2 1988 58/M + T N Skin, rectal, lung Primary with plasma cell dyscrasia CHF
6 Current series Case 1 71/F + T Y Bowel,rectum,muscle Rheumatoid arthritis CHF
7 Current series Case 2 54/F + T Y Rectal, SQ, fat, submand bx Primary with plasma cell dyscrasia CHF
8 Current series Case 3 61/F + T Y Myocardium Primary with plasma cell dyscrasia CHF
9 Current series Case 4 57/F + E Y Skin, lung Primary with plasma cell dyscrasia Treated CHF
10 Current series Case 5 81/F + + E Y Rectal Primary with plasma cell dyscrasia Idiopathic

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