Disappearing nodules: spontaneously regressing pulmonary amyloidosis

Abstract

A case report of spontaneous regression of pulmonary amyloidosis, diffuse interstitial pattern, in an elderly patient.

Case Details

Disease Location

Lung, lymph nodes

Personal Characteristics

82-year-old woman. History of hypothyroidism, left breast cancer with mastectomy, hypertension, hyperlipidemia, diet-controlled diabetes and gastro-oesophageal reflux disease

Clinical Characteristics

Presented for evaluation of chest pain. Prior to presentation, she tripped over a loose brick and suffered a mechanical fall with injury to her left knee. She noticed left-sided chest pain 1 day later without radiation, which was worsened with eating. Chest x-ray was notable for flattened diaphragms and hyperinflation. D-dimer was elevated. CT scan demonstrated septal thickening, mediastinal lymphadenopathy, hilar lymphadenopathy, calcified hilar lymph nodes, right hilar hypodensity, and innumerable 2–3 mm pulmonary nodules. Bronchoscopy with endobronchial ultrasound-guided biopsy was performed. There were no tracheobronchial abnormalities noted. Biopsies of station 7 and r11 lymph nodes were performed, with limited lymphoid cells present. Transbronchial biopsy of the right upper lobe showed thickened vascular walls and a deposit of amorphous material around the bronchiole. The patient underwent mediastinoscopy, and lymph node biopsies of l2, r2, and r4 were performed. Findings were consistent with amyloidosis. Bone marrow biopsy revealed hypercellular marrow and trilineage haematopoiesis with 5%–10% plasma cells and no evidence of frank myeloma.

Remission Characteristics

CT imaging 6 months later, a decrease in parenchymal disease was noted.

Treatment & Mechanisms

Proposed Remission Mechanisms

None reported

Clinical Treatment

Biopsy, mediastinoscopy

Non-Clinical Treatment

None reported