Procedures: Fellow Case Report Poster - Procedures |

A Rare Case of PET Scan Positive Amyloidosis in Sjögren Syndrome FREE TO VIEW

Hammad Arshad, MD; Meilin Young, MD; Rajashekar Adurty, MD
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Allegheny General Hospital, Pittsburgh, PA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):991A. doi:10.1016/j.chest.2016.08.1097
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SESSION TITLE: Fellow Case Report Poster - Procedures

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Sjogren syndrome(SS), is a chronic inflammatory disorder characterized by lymphocytic infiltration of exocrine glands. Pulmonary amyloidosis secondary to Sjogren Syndrome is rare with a paucity of data on its clinical and radiological manifestations.

CASE PRESENTATION: A 65 year old female with past medical history of COPD and Sjogren’s syndrome was found to have 1.6 cm right lower lobe and 1.4 cm left upper lobe irregular nodules as an incidental CT scan finding after a traumatic injury to her chest.Her review of systems was significant for dry mouth and non productive cough. A PET scan obtained as a follow up showed moderate FDG uptake with SUV of 4.0 and 2.3 respectively. Due to intermediate risks with a history of smoking and family history of breast cancer , tissue specimen via transbronchial biopsy were obtained to rule out cancer . Histology showed amorphous tissue material that stained positive for Congo red consistent with diagnosis of amyloidosis. She subsequently opted to have the right lower lobe nodule resected via a VATS procedure that conformed the diagnosis of amyloidosis.

DISCUSSION: Sjogren syndrome is an autoimmune disease associated with a multitude of pulmonary lympho proliferative disorders. The extracellular deposition of its insoluble amyloid proteins can present with an interstitial and nodular pattern. The most common manifestation is the bilateral pulmonary nodules.The nodules have a peripheral lower lobe distribution and tend to have no FDG activity on PET scan . The transthoracic resection is the recommended approach for diagnosis, however advanced bronchoscopic techniques including electromagnetic navigation bronchoscopy could be utilized to biopsy and diagnose the condition. Bleeding remains a significant risk secondary to pulmonary vascular involvement. We report a rare case of bilateral pulmonary nodules in a patient with Sjogren syndrome that had significant FDG uptake and was diagnosed as amyloidosis.

CONCLUSIONS: Amyloidosis should be considered in the differential diagnosis of bilateral pulmonary nodule in patients with Sjogren’s syndrome. Tissue samples sould be obtained from nodules with increased FDG activity or intermediate risks to rule out active malignancy

Reference #1: FDG PET Scanning in Pulmonary Amyloidosis; Baqir et al ; J Nucl Med 2014; 55:565-568

Reference #2: Pulmonary amyloidosis in Sjogren Syndrome: A case report and systemic review of the literature; Rajagopala et al; Respirology 2010; 15:860-868

DISCLOSURE: The following authors have nothing to disclose: Hammad Arshad, Meilin Young, Rajashekar Adurty

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