Ishibashi Naoya, Sugawara Takafumi, Ashino Yugo, Yabe Ryuga, Nonomura Ryo, Oshima Yutaka, Sasaki Takanobu
Department of Thoracic Surgery Tohoku Medical and Pharmaceutical University Hospital Sendai-shi Japan.
Department of Respiratory Medicine Sendai City Hospital Sendai-shi Japan.
Respirol Case Rep. 2024 Jul 31;12(8):e01445. doi: 10.1002/rcr2.1445. eCollection 2024 Aug.
An 80-year-old man with a history of Bence-Jones potein (BJP) λ-type multiple myeloma (MM), which had been in remission for 16 years, was examined for shortness of breath and was found to have bilateral pleural and pericardial effusions. A pleural fluid test and a pleural biopsy under local anaesthesia performed by a previous physician failed to make the diagnosis. Despite diuretic therapy, his condition necessitated frequent thoracentesis. The patient was referred to our hospital and thoracoscopic pleural and pericardial biopsies performed under general anaesthesia revealed λ-type AL amyloidosis, indicating a relapse of MM. Despite drug therapy for MM, the patient died from aspiration pneumonia. The case underscores the importance of considering amyloidosis in differential diagnoses for refractory effusions, especially in patients with a history of MM, even after long-term remission.
一名80岁男性，有λ型本-周蛋白（BJP）多发性骨髓瘤（MM）病史，已缓解16年，因气短接受检查，发现双侧胸腔和心包积液。先前的医生进行的胸腔积液检查和局部麻醉下的胸膜活检未能明确诊断。尽管进行了利尿治疗，但他的病情仍需要频繁胸腔穿刺。患者被转诊至我院，全身麻醉下进行的胸腔镜胸膜和心包活检显示为λ型AL淀粉样变性，提示MM复发。尽管对MM进行了药物治疗，患者仍死于吸入性肺炎。该病例强调了在难治性积液的鉴别诊断中考虑淀粉样变性的重要性，特别是在有MM病史的患者中，即使是在长期缓解之后。
