Pleural Lesions Secondary to AA Amyloidosis Associated with Rheumatoid Arthritis Diagnosed by Thoracoscopy Under Local Anesthesia: a Case Report

DOI
  • Doi Fumika
    Division of Pulmonology, Department of Internal Medicine, Nagaoka Red Cross Hospital
  • Shimaoka Yuichi
    Division of Pulmonology, Department of Internal Medicine, Nagaoka Red Cross Hospital
  • Koshio Jun
    Division of Pulmonology, Department of Internal Medicine, Nagaoka Red Cross Hospital
  • Ishida Akira
    Division of Pulmonology, Department of Internal Medicine, Nagaoka Red Cross Hospital
  • Numata Yuka
    Division of Pulmonology, Department of Internal Medicine, Nagaoka Red Cross Hospital
  • Nishibori Takeaki
    Department of Infectious Disease, Nagaoka Red Cross Hospital
  • Saeki Takako
    Division of Rheumatology and Nephrology, Department of Internal Medicine, Nagaoka Red Cross Hospital
  • Sato Seijiro
    Department of General Thoracic Surgery, Nagaoka Red Cross Hospital
  • Shinohara Hirohiko
    Department of General Thoracic Surgery, Nagaoka Red Cross Hospital
  • Sato Kazuhiro
    Division of Pulmonology, Department of Internal Medicine, Nagaoka Red Cross Hospital

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Other Title
  • 局所麻酔下胸腔鏡検査にて関節リウマチに関連した続発性AAアミロイドーシスの胸膜病変と診断した1例

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Abstract

<p>Background. Patients with rheumatoid arthritis often present with pleural effusion. Amyloidosis is a rare cause of massive pleural effusion. Case. A 71-year-old woman with a 35-year medical history of rheumatoid arthritis was referred to our hospital. Four years previously, her renal function had begun to deteriorate. Gradually, she started complaining of dyspnea and developed massive left pleural effusion. She underwent thoracoscopic pleural biopsy under local anesthesia, which revealed amyloid deposition in the parietal pleura. The patient was diagnosed with pleural lesions secondary to AA amyloidosis associated with rheumatoid arthritis. After treatment with etanercept, her serum amyloid A protein levels decreased. Her dyspnea improved as her pleural effusion decreased. Conclusion. When patients with rheumatoid arthritis develop refractory pleural effusion, it is important to include pleural amyloidosis as a differential diagnosis and to perform a pleural biopsy to search for amyloid deposition.</p>

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