Nodular lung disease with five year survival and unilateral pleural effusion in AL amyloidosis

A 67-year-old female patient with biopsy proven AL systemic amyloidosis dev eloped rapidly progressive dyspnea. Chest roentgenogram and CT scan reveale d a large right pleural effusion in addition to nodular lesions with bilate ral hilar lymphadenopathy. The patient's serum showed IgG lambda type monoc lonal gammopathy and she also had Bence Jones proteinuria. The pleural effu sion was an exudate that contained many mononuclear cells and a high concen tration of protein. Cardiac function was not seriously disturbed Except for amyloidosis, no other causes for the severe pleural effusion were found Th is patient was treated with chemical pleurodesis using Picibanil and a low dose of prednisolone. Eighteen months after this treatment, her right pleur al effusion did not recur. Bronchopulmonary tissues are known to be frequen tly involved by AL systemic amyloidosis, but a nodular pattern of pulmonary amyloid deposition and a unilateral large pleural effusion are rare clinic al manifestations in this disease.