CASE STUDY:
64-Year-Old Hispanic Female With Shortness of Breath, Weight Loss, and Diarrhea

CLINICAL INFORMATION

IMAGING

CT revealed multiple small nodules, a few mm in diameter, with some predominance along the fissures, in the lung periphery, and in relation to interlobular septa. A large confluent mass and patchy areas of ground-glass opacity were also visible (Figure 1, Figure 2).

Figure 1. Noncontrast chest CT scan, December 12, 2003. CT showing multiple small nodules, a few mm in diameter, with some predominance along the fissures and in the lung periphery. A large confluent mass and patchy areas of ground-glass opacity are also visible.

Figure 2. Noncontrast chest CT scan, December 12, 2003. CT near the lung base showing multiple small nodules. Patchy areas of ground-glass opacity are also visible.

The patient underwent a bronchoscopy with transbronchial biopsies of the right middle and right lower lobes. The results were reported as showing fibrosis, but no granulomas, nor any evidence of malignancy (Figure 3). Despite the absence of granulomas, sarcoidosis was still felt to be a consideration and the patient was referred for a Kveim-Siltzbach test. During this time, she also developed hematemesis and therefore underwent an esophagogastroduodenoscopy (EGD) with gastric biopsies. These showed edematous gastric mucosa with focal chronic inflammation but no evidence for H. pylori (Figure 4). A Congo red dye of the biopsy specimens was performed and based on this the diagnosis of amyloidosis was made several days later.

Figure 3. Low-power view of transbronchial biopsy showing thickened septal walls and vascular wall thickening.

Figure 4. High-power view of gastric mucosa biopsy showing endothelial wall thickening.