Nodular pulmonary amyloidosis and Sjögren's syndrome in a patient treated with intermittent hemodialysis.
In the available literature, we have found the descriptions of 5 cases of nodular pulmonary amyloidosis associated with Sjögren's syndrome. In our practice, such a case has occurred in a patient with chronic renal failure. A 53-year-old woman underwent nephrological, rheumatological, and pulmonological examinations because of end-stage renal disease with a small cirrhotic kidney in renal ultrasound examination, pulmonary nodules, and xerophthalmia. Serological data revealed a slightly positive rheumatoid factor, antinuclear antibodies, anti-SS-A, anti-SS-B, and anti-RNP/Sm antibodies. Schirmer's test was positive on both sides and Sjögren's syndrome was recognized. Pulmonological examinations (the chest radiograph and CT scan, bronchofiberoscopy, culture of bronchial washings, bronchial biopsy, pleural effusion analysis, and a thick-needle biopsy) failed to determine the etiology of nodular changes in lungs. Immunofluorescence studies in the skin biopsy specimen showed IgM-positive staining. After 2 years of treatment with IHD, a toracoscopy was performed with enucleation of the nodules from the right lung. Histological examination showed massive deposits of amyloid, which allowed for a diagnosis of diffusive nodular pulmonary amyloidosis.
Niepolski
Leszek
L
B. Braun Avitum Poland Dialysis Center, Nowy Tomyśl, Poland. leszek.niepolski@avitum.com.pl
Grzegorzewska
Alicja E
AE
Szymaś
Janusz
J
D058186:Acute Kidney Injury / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D000686:Amyloidosis / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012859:Sjogren's Syndrome / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome