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Successful management of refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis by vincristine adriamycin dexamethasone chemotherapy: a case report.

Araoka T, Takeoka H, Nishioka K, Ikeda M, Kondo M, Hoshina A, Kishi S, Araki M, Mimura R, Murakami T, Mima A, Nagai K, Abe H, Doi T - J Med Case Rep (2010)

Bottom Line: One month before admission, his dyspnea had got worse, and his chest radiograph showed bilateral pleural effusion; the pleural effusion was ascertained to be a transudate.The conventionally used therapeutic measures, including diuretics and thoracocentesis, failed to control pleural effusion.Administration of vincristine, adriamycin, and dexamethasone chemotherapy led to successful resolution of the effusion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Nephrology, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan. htakeoka@ares.eonet.ne.jp.

ABSTRACT

Introduction: Refractory pleural effusion in systemic immunoglobulin light chain amyloidosis without cardiac decompensation is rarely reported and has a poor prognosis in general (a median survival of 1.6 months). Moreover, the optimum treatment for this condition is still undecided. This is the first report on the successful use of vincristine, adriamycin and dexamethasone chemotherapy for refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis without cardiac decompensation.

Case presentation: We report the case of a 68-year old Japanese male with systemic immunoglobulin light chain amyloidosis presenting with bilateral pleural effusion (more severe on the right side) in the absence of cardiac decompensation that was refractory to diuretic therapy. The patient was admitted for fatigue, exertional dyspnea, and bilateral lower extremity edema. He had been receiving intermittent melphalan and prednisone chemotherapy for seven years. One month before admission, his dyspnea had got worse, and his chest radiograph showed bilateral pleural effusion; the pleural effusion was ascertained to be a transudate. The conventionally used therapeutic measures, including diuretics and thoracocentesis, failed to control pleural effusion. Administration of vincristine, adriamycin, and dexamethasone chemotherapy led to successful resolution of the effusion.

Conclusion: Treatment with vincristine, adriamycin, and dexamethasone chemotherapy was effective for the refractory pleural effusion in systemic immunoglobulin light chain amyloidosis without cardiac decompensation and appears to be associated with improvement in our patient's prognosis.

No MeSH data available.


Related in: MedlinePlus

Pleural effusion was significantly alleviated by vincristine, adriamycin and dexamethasone chemotherapy. Chest radiograph (A) and computed tomography imaging (B) showing pleural effusion at admission. Chest radiograph (C) and computed tomography imaging (D) showing significant improvement 30 days after VAD.
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Figure 1: Pleural effusion was significantly alleviated by vincristine, adriamycin and dexamethasone chemotherapy. Chest radiograph (A) and computed tomography imaging (B) showing pleural effusion at admission. Chest radiograph (C) and computed tomography imaging (D) showing significant improvement 30 days after VAD.

Mentions: At admission, his chest radiograph image showed a moderate effusion on the right side and slight effusion in the left. The computed tomography imaging of his chest revealed moderate pleural effusion in the right lung and atelectasis of the right lower robe (Figure 1A, B).


Successful management of refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis by vincristine adriamycin dexamethasone chemotherapy: a case report.

Araoka T, Takeoka H, Nishioka K, Ikeda M, Kondo M, Hoshina A, Kishi S, Araki M, Mimura R, Murakami T, Mima A, Nagai K, Abe H, Doi T - J Med Case Rep (2010)

Pleural effusion was significantly alleviated by vincristine, adriamycin and dexamethasone chemotherapy. Chest radiograph (A) and computed tomography imaging (B) showing pleural effusion at admission. Chest radiograph (C) and computed tomography imaging (D) showing significant improvement 30 days after VAD.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2967566&req=5

Figure 1: Pleural effusion was significantly alleviated by vincristine, adriamycin and dexamethasone chemotherapy. Chest radiograph (A) and computed tomography imaging (B) showing pleural effusion at admission. Chest radiograph (C) and computed tomography imaging (D) showing significant improvement 30 days after VAD.
Mentions: At admission, his chest radiograph image showed a moderate effusion on the right side and slight effusion in the left. The computed tomography imaging of his chest revealed moderate pleural effusion in the right lung and atelectasis of the right lower robe (Figure 1A, B).

Bottom Line: One month before admission, his dyspnea had got worse, and his chest radiograph showed bilateral pleural effusion; the pleural effusion was ascertained to be a transudate.The conventionally used therapeutic measures, including diuretics and thoracocentesis, failed to control pleural effusion.Administration of vincristine, adriamycin, and dexamethasone chemotherapy led to successful resolution of the effusion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Nephrology, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan. htakeoka@ares.eonet.ne.jp.

ABSTRACT

Introduction: Refractory pleural effusion in systemic immunoglobulin light chain amyloidosis without cardiac decompensation is rarely reported and has a poor prognosis in general (a median survival of 1.6 months). Moreover, the optimum treatment for this condition is still undecided. This is the first report on the successful use of vincristine, adriamycin and dexamethasone chemotherapy for refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis without cardiac decompensation.

Case presentation: We report the case of a 68-year old Japanese male with systemic immunoglobulin light chain amyloidosis presenting with bilateral pleural effusion (more severe on the right side) in the absence of cardiac decompensation that was refractory to diuretic therapy. The patient was admitted for fatigue, exertional dyspnea, and bilateral lower extremity edema. He had been receiving intermittent melphalan and prednisone chemotherapy for seven years. One month before admission, his dyspnea had got worse, and his chest radiograph showed bilateral pleural effusion; the pleural effusion was ascertained to be a transudate. The conventionally used therapeutic measures, including diuretics and thoracocentesis, failed to control pleural effusion. Administration of vincristine, adriamycin, and dexamethasone chemotherapy led to successful resolution of the effusion.

Conclusion: Treatment with vincristine, adriamycin, and dexamethasone chemotherapy was effective for the refractory pleural effusion in systemic immunoglobulin light chain amyloidosis without cardiac decompensation and appears to be associated with improvement in our patient's prognosis.

No MeSH data available.


Related in: MedlinePlus