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




Successful management of refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis by vincristine adriamycin dexamethasone chemotherapy: a case report - Download this document for free, or read online. Document in PDF available to download.

Journal of Medical Case Reports

, 4:322

First Online: 18 October 2010Received: 10 December 2009Accepted: 18 October 2010DOI: 10.1186-1752-1947-4-322

Cite this article as: Araoka, T., Takeoka, H., Nishioka, K. et al. J Med Case Reports 2010 4: 322. doi:10.1186-1752-1947-4-322

Abstract

IntroductionRefractory 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 presentationWe 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.

ConclusionTreatment 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.

AbbreviationsLVleft ventricular

MPmelphalan and prednisone

VADvincristine, adriamycin, and dexamethasone

VEGFvascular endothelial growth factor

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-4-322 contains supplementary material, which is available to authorized users.

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Author: Toshikazu Araoka - Hiroya Takeoka - Keisuke Nishioka - Masaki Ikeda - Makiko Kondo - Azusa Hoshina - Seiji Kishi - Makoto 

Source: https://link.springer.com/



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