Successful multimodal endobronchial treatment of severe tracheobronchial amyloidosis

A previously healthy woman in her 40s presented with a 6-month history of increasing cough and breathlessness following COVID-19 infection. She experienced vocal hoarseness and recurrent respiratory infections during this time, requiring several antibiotic courses. She was treated for gastro-oesophageal reflux and trialled on inhaled corticosteroids, without improvement. Further work up included CT scan, demonstrating tracheal thickening, endobronchial narrowing and mucosal abnormalities. Bronchoscopy with biopsies demonstrated amyloidosis. She was referred to a specialist centre with further work up including serum amyloid P component (SAP) scan, echo and bloodwork. She was diagnosed with localised tracheobronchial amyloidosis and referred to interventional respiratory for treatment. Bronchoscopy demonstrated severe narrowing in left main, left upper and lower lobes and to a lesser extent, the right main bronchus. Endobronchial treatment included diode laser therapy, electrocautery and cryorecanalisation. Significant improvement was seen on 3 months post surveillance bronchoscopy. Following this treatment, the patient experienced sustained improvement in breathlessness and cough.