Recurrent Pleural Effusions in an Elderly Female Patient With Renal Amyloidosis

Amyloidosis is a rare and severe disease process that is often systemic in nature. Clinical presentations of patients include involvement of various organ systems such as the kidneys, heart, and lungs. As such, presentations of amyloidosis can be peculiar and can greatly mimic other conditions, making diagnosis very difficult. Delays in diagnosis or misdiagnoses can lead to significant morbidity and great potential for multi-organ dysfunctions. We describe the case of an elderly female patient without a known cardiac history who presented to the emergency department with increasing shortness of breath. This patient had a recent history of renal amyloidosis requiring regular chemotherapy. The patient was found to have extensive secondary fluid buildup in the pleural space, resulting in recurrent pleural effusions requiring repeated thoracenteses. Pleural effusions are rare complications of systemic amyloidosis that are poorly understood. After thorough evaluation of the cardiac and renal systems and ruling out malignancy, we suspected that direct infiltration of the pleura with amyloid fibrils and exacerbation of fluid overload from renal failure led to the disease presentation. With proper management of the patient's end-stage renal disease with dialysis, the fluid-overload state with loop diuretics, and effective use of thoracentesis, the patient's condition showed improvement. This report serves to educate on the pathophysiology of amyloidosis and provide a clinical anecdote of the presentation, course of this chronic disease process, treatment methodologies, and future of therapy.