title: Hereditary Amyloidosis with Recurrent Lung Infiltrates.
abstract: BACKGROUND Amyloidosis is a protein conformational disorder characterized by extracellular deposition of amyloid fibrils in extracellular tissue. Lung involvement is most commonly caused by secondary AL amyloidosis. The familial autosomal-dominant senile transthyretin (ATTR) disease manifests mainly as polyneuropathy and restrictive cardiomyopathy denoting the name familial amyloidotic polyneuropathy (FAP). Rarely, this form manifests with clinical and radiologically relevant respiratory tract symptoms and lung involvement. CASE REPORT A 51-year-old male former smoker presented with progressive lower-extremity weakness of several months' duration. He was ultimately diagnosed with chronic demyelinating polyneuropathy and treated with intravenous immunoglobulin therapy. Subsequently, he was admitted with heart failure symptoms and pulmonary infiltrates and his echocardiogram showed a 'myocardial speckled pattern', prompting an endomyocardial biopsy, which showed transthyretin amyloid deposition. He was started on diflunisal. Additionally, serial radiographic imaging of his chest over 3 different admissions for cough, dyspnea, hypoxemia, and lethargy demonstrated recurrent pulmonary infiltrates. A fiberoptic bronchoscopy with trans-bronchial biopsies revealed amyloid deposition in the lung tissue. CONCLUSIONS The clinical presentation of recurrent or persistent pulmonary symptoms and fleeting infiltrates on imaging in a patient with familial amyloidotic polyneuropathy is not common; when present, it should raise the suspicion of respiratory tract involvement.
authors.affiliation: Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, estchester Medical Center, New York Medical College, Valhalla, NY, USA.
authors.forename: Alberto E
authors.initials: AE
authors.lastname: Revelo
authors.affiliation: Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
authors.forename: Crischelle
authors.initials: C
authors.lastname: Magaspi
authors.affiliation: Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
authors.forename: George
authors.initials: G
authors.lastname: Maguire
authors.affiliation: Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
mesh_terms: D028226:Amyloidosis, Familial / Q000150:complications* / Q000175:diagnosis; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D001999:Bronchoscopy; D003937:Diagnosis, Differential; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed