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首页> 外文期刊>Journal of Medical Case Reports >Successful management of refractory pleural effusion due to systemic immunoglobulin light chain amyloidosis by vincristine adriamycin dexamethasone chemotherapy: a case report
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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

机译：长春新碱阿霉素地塞米松化疗成功治疗因全身性免疫球蛋白轻链淀粉样变引起的难治性胸腔积液：一例报告

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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.
机译：引言很少报道全身性免疫球蛋白轻链淀粉样变性中难治性胸腔积液而无心脏代偿失调，预后一般较差（中位生存期为1.6个月）。而且，对于这种情况的最佳治疗仍未确定。这是关于长春新碱，阿霉素和地塞米松化学疗法成功治疗因系统性免疫球蛋白轻链淀粉样变性而导致的难治性胸腔积液的首次报道，而没有心脏代偿失调。病例介绍我们报告了一名68岁的日本男性，患有系统性免疫球蛋白轻链淀粉样变性病，伴有双侧胸腔积液（右侧更为严重），但没有心脏失代偿，这对利尿剂治疗无效。该患者因疲劳，劳累性呼吸困难和双侧下肢浮肿而入院。他已接受间歇性美法仑和泼尼松化疗达七年之久。入院前一个月，他的呼吸困难加重了，胸部X光片显示双侧胸腔积液。确定胸腔积液为渗出液。常规使用的治疗措施，包括利尿剂和胸腔穿刺术，未能控制胸腔积液。长春新碱，阿霉素和地塞米松化学疗法的使用成功地解决了积液。结论长春新碱，阿霉素和地塞米松化学疗法可有效治疗全身性免疫球蛋白轻链淀粉样变难治性胸腔积液，而无心脏代偿失调，并可能与患者预后的改善有关。

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