[Primary amyloidosis complicated with chronic myelomonocytic leukemia]

A 79-year-old male was admitted to our hospital because of abnormal shadows in both lungs on chest X-ray film. He had a 5-year history of repeated bleeding episodes of unknown etiology before admission. Transbronchial lung biopsy revealed the alveolar septal type of lung amyloidosis. His serum contained a monoclonal IgA-lambda type protein but there was no evidence of multiple myeloma. A diagnosis of primary amyloidosis was made. On admission, his hematological findings revealed the coexistence of chronic myelomonocytic leukemia (CMML). Coexistence of primary amyloidosis and CMML is extremely rare. Because monocytes are known to play an essential role in the degenerative processes of serum amyloid precursor, it was suggested that his amyloidosis was accelerated by the onset of CMML through certain dysfunctions of pathological monocytes.