The Journal of the Japanese Respiratory Society ONLINE JOURNAL
ABSTRACT
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Article in Japanese
Case Report
Successful treatment of pleurodesis for seemingly intractable pleural effusion in pleural amyloidosis with rheumatoid arthritis
Aiko Masunaga1), Nahoko Takeda1), Kimitaka Akaike1), Kaori Tsumori2), Eisuke Goto1), Hidenori Ichiyasu1) and Hirotsugu Kohrogi1)
1)Department of Respiratory Medicine, Kumamoto University Hospital
2)Department of Respiratory Medicine, Japanese Red Cross Kumamoto Hospital
ABSTRACT
We report a case of secondary amyloidosis with pleural involvement in a patient with rheumatoid arthritis. A 77-year-old man had received a diagnosis of rheumatoid arthritis 10 years previously. Bilateral pleural effusion of unknown etiology was noted 2 years prior to admission. A biopsy of the left pleura by video-assisted thoracic surgery did not reveal any evidence of the cause of his pleural effusion. The histological findings revealed chronic inflammation of the pleura on a hematoxylin-eosin (HE) stain, but treatment with an increased dose of corticosteroid did not improve his effusion. Right pneumothorax then developed. Based on the histological findings of a Congo red stain, the diagnosis was changed to pleural amyloidosis. An initial attempt at pleurodesis with OK-432 and a pleural patch with the patient's own blood was attempted but was not successful. Subsequently, pleurodesis with OK-432 and the patient's own blood improved his pleural effusion and pneumothorax. Pleural involvement in amyloidosis is extremely rare and is difficult to treat.
KEYWORDS: Rheumatoid arthritis, Secondary amyloidosis, Intractable pleural effusion, Biopsy of the pleura, Pleurodesis
RECEIVED: 2011.3.9
JJRS, 49(12): 897-902, 2011
