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A Rare and Unusual Diagnosis With Recurrent Pneumonia FREE TO VIEW

Clinton Colaco, MD; Brendon Colaco, MD; Mohan Rudrappa, MD; Rajani Jagana, MDS; Penchala Mittadodla, MD; Mohammad Siddiqui, MD
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University of Arkansas for Medical Sciences and John McClellan VA Medical Center, Little Rock, AR

Chest. 2014;146(4_MeetingAbstracts):330A. doi:10.1378/chest.1994086
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SESSION TITLE: Miscellaneous Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: We present a case of recurrent pneumonia in a polysubstance abuser. After an exhaustive work-up, a diagnosis of pulmonary amyloidosis was made. Amyloidosis is a disease where deposition of fibrillar amyloid material extracellularly affects multiple organs.

CASE PRESENTATION: A 50 year old woman presented with dyspnea, cough with greenish expectoration, subjective fevers, weight loss and malaise. Patient had recurrent bouts of pneumonia for many years. She also abused cocaine, methamphetamine, tobacco and alcohol. Physical exam was remarkable for a thin, emaciated woman with poor dentition with coarse rhonchi bilaterally. Laboratory work-up showed a leukocytosis of 22 thousand. Imaging revealed bilateral patchy airspace opacities with some nodules, mediastinal lymphadenopathy. Patient was treated with broad spectrum antibiotics for presumed pneumonia. An infectious work up including Hepatitis serologies and HIV was negative. A swallow study was not concerning for aspiration. Patient underwent bronchoscopy with trans bronchial needle aspiration of a station 7 node, bronchoalveolar lavage from the right upper lobe and trans bronchial biopsies from the right lower lobe. Cultures from the lavage, and cytology from the lymph node was also negative,. The transbronchial biopsies showed presence of amyloid of unidentifiable type.

DISCUSSION: Solitary pulmonary amyloidosis is a rare condition. On account of the history of polysubstance abuse, our differential diagnoses included recurrent aspiration, toxic lung injury secondary to drugs, fungal or atypical bacterial pneumonia with possible immunocompromised status, and malignancy with secondary infection. There are scant reports of cases with multiple pulmonary nodules in relatively healthy patients with solitary pulmonary amyloidosis. Usually pulmonary involvement is seen in diffuse systemic disease.

CONCLUSIONS: Our patient likely had superimposed infectious pneumonia in the setting of underlying pulmonary amyloidosis. Pulmonary amyloidosis though not common, should be considered in patients with lung nodules and recurrent infections.

Reference #1: Zhang LN et al. (2012). Mimicking pulmonary multiple metastatic tumors: A case of primary nodular parenchymal pulmonary amyloidosis with review of the literature. Oncology letters, 4(6), 1366-1370.

Reference #2: Shahidi M et al. (2014). Multinodular pulmonary amyloidosis without systemic involvement. Chest, 145(3 Suppl), 556A-556A.

DISCLOSURE: The following authors have nothing to disclose: Clinton Colaco, Brendon Colaco, Mohan Rudrappa, Rajani Jagana, Penchala Mittadodla, Mohammad Siddiqui

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