A case of cardiac amyloidosis with diuretic-refractory pleural effusions treated with bevacizumab.
Cardiac amyloidosis describes a clinical disorder caused by infiltration of abnormal insoluble fibrils in the heart, characterized by progressive heart failure and a grave prognosis. Pleural effusion in cardiac amyloidosis may represent a sign of heart failure, but it can also result from pleural infiltration of amyloid, manifested by recurrent large fluid accumulations. Recently, the role of vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of refractory pleural effusion. We report a case of a 53 year-old female patient with cardiac amyloidosis who presented with recurrent accumulation of large pleural effusions. She was initially treated with high dose loop diuretics, but the pleural effusion persisted, with the daily amount of drainage averaging 1 L/day. Accumulation of pleural fluid did not subside after 3 cycles of melphalan/prednisolone therapy. After the introduction of bevacizumab, an anti-VEGF antibody, the amount of pleural effusion decreased significantly. Efficacy of anti-VEGF therapy for refractory pleural effusions needs to be defined through further studies.
Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
Suk-Hyang
SH
Bae
Jin Yeon
JY
Hwang
Woo Jae
WJ
Kim
Hyun-Hwa
HH
Yoon
Jung Min
JM
Kim
Young Hee
YH
Nam
Hee Gyung
HG
Baek
Yong Rak
YR
Cho
Sun-Yi
SY
Park
Jeong Hwan
JH
Kim
Sung-Hyun
SH
Kim
Tae-Ho
TH
Park
Gi-Nam
GN
Lee
Seo-Hee
SH
Rha
Young Dae
YD
Kim
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