Amyloidosis with Periorbital Ecchymosis Triggered by Bronchoscopy: a Case Report

Abstract

Background. Amyloidosis is a disease in which amyloid protein is deposited extracellularly in various organs throughout the body. This results in the progressive disruption of tissue structures, leading to the development of disease. Subcutaneous bleeding, referred to as amyloid purpura, is one of the disease symptoms. We herein report a case of purpura around the orbit that was triggered by bronchoscopy. Case Presentation. A 78-year-old woman was referred to our hospital after swollen lymph nodes were detected in the mediastinum, axilla, and supraclavicular fossa on a computed tomography (CT) scan during a health check. Approximately 2 hours after examining the swollen lymph nodes with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), purpuric changes were observed around both eye sockets. Although no pain was reported, the purpura worsened overnight. A cranial CT scan was performed but no abnormalities were found. Bilateral subcutaneous bleeding of the eyelids, bilateral subconjunctival bleeding, and edema were noted on an ophthalmologic examination. The purpura disappeared spontaneously. The patient was subsequently diagnosed with amyloidosis based on the pathological findings of EBUS-TBNA, indicating that the periorbital purpura was a sign of raccoon eyes. Conclusion. It is important to consider amyloidosis as a possible diagnosis for the characteristic purpura that might appear after an invasive procedure, such as bronchoscopy.