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Pleural amyloidosis with recurrent pleural effusion and pulmonary embolism: A case report
- Source :
- Medicine
- Publication Year :
- 2019
-
Abstract
- Rational: Clinical and radiologic manifestations of pleural amyloidosis are non-specific. And it can easily be missed or misdiagnosed. Meanwhile, few studies document amyloidosis presenting with pulmonary infarcts at the same time. Hereby, we report a case of immunoglobulin light chain amyloidosis (AL) pleural amyloidosis with pulmonary embolism rarely reported. Patient concerns: A 66-year-old male patient who suffered recurrent pleural effusion for more than 6 months and coughed for 2 months was admitted to hospital for clear diagnosis and treatment. He was previously engaged in a job which exposed him to dust and talcum powder for a long time. He underwent right thoracentesis and anti-infective treatment before admission. The patient's cough and shortness of breath were slightly relieved. He still experienced pleural effusion and had symptoms of cough and shortness of breath. Diagnosis: Chest X-ray demonstrated bilateral pleural effusion. Chest computed tomography (CT) angiography demonstrated left lower pulmonary embolism. The thorascopy showed hyperaemia and black tissue of the parietal pleura, which were biopsied. The pathological diagnosis was amyloidosis. The final diagnosis of this patient was AL pleural amyloidosis and left lower pulmonary embolism. Intervention: During the hospitalization, the patient underwent thoracentesis several times without any conclusive diagnosis. After the diagnosis of pleural amyloidosis, the patient was repeatedly advised to undergo bone marrow biopsy and pleurodesis which the patient refused. For pulmonary embolism, Nadroparin calcium combined Warfarin were administered as anticoagulative therapy. Outcomes: The pulmonary embolism resolved 13 days after the anticoagulant therapy. The patient refused treatment for pleural effusion and requested for discharge. At the time of discharge, shortness of breath was relieved, and the pleural effusion had decreased. The patient was lost to follow-up. Lessons: Amyloidosis is a rare disease which can be ignored by many clinicians. It needs to be diagnosed promptly since the prognosis of amyloidosis is poor. Clinicians must improve relevant understandings of this kind of disease so as not to delay the diagnosis and treatment. We must be alert to the occurrence of embolic disease among amyloidosis patients. Last but not least, we should also think of the possibility of amyloidosis in patients with pulmonary embolism and recurrent pleural effusion.
- Subjects :
- Male
medicine.medical_specialty
Pleural effusion
thoracentesis
medicine.medical_treatment
Thoracentesis
Immunoglobulin Light-chain Amyloidosis
03 medical and health sciences
0302 clinical medicine
Recurrence
thoracoscope
medicine
Humans
030212 general & internal medicine
Clinical Case Report
Aged
amyloidosis
business.industry
Amyloidosis
Thoracoscopy
Warfarin
Anticoagulants
General Medicine
medicine.disease
Pulmonary embolism
respiratory tract diseases
Pleural Effusion
030220 oncology & carcinogenesis
Pleura
Radiology
business
Pulmonary Embolism
Tomography, X-Ray Computed
Pleurodesis
medicine.drug
Rare disease
Research Article
Subjects
Details
- ISSN :
- 15365964
- Volume :
- 98
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Medicine
- Accession number :
- edsair.doi.dedup.....342dce44d0e714ca0e1f5381cc6dac6e