2023 Volume 45 Issue 5 Pages 345-351
Background. Patients with rheumatoid arthritis often present with pleural effusion. Amyloidosis is a rare cause of massive pleural effusion. Case. A 71-year-old woman with a 35-year medical history of rheumatoid arthritis was referred to our hospital. Four years previously, her renal function had begun to deteriorate. Gradually, she started complaining of dyspnea and developed massive left pleural effusion. She underwent thoracoscopic pleural biopsy under local anesthesia, which revealed amyloid deposition in the parietal pleura. The patient was diagnosed with pleural lesions secondary to AA amyloidosis associated with rheumatoid arthritis. After treatment with etanercept, her serum amyloid A protein levels decreased. Her dyspnea improved as her pleural effusion decreased. Conclusion. When patients with rheumatoid arthritis develop refractory pleural effusion, it is important to include pleural amyloidosis as a differential diagnosis and to perform a pleural biopsy to search for amyloid deposition.
