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• W4387248632 abstract "SESSION TITLE: Pulmonary Manifestations of Systemic Disease Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Amyloid light-chain amyloidosis occurs due to the deposition of immunoglobulin light chains derived proteins, usually with multisystem involvement. (1) Pulmonary amyloidosis is a rare disease, and the identification of amyloid deposits is essential for its diagnosis. Three common patterns of pulmonary amyloidosis on computed tomography (CT) chest are tracheobronchial, nodular parenchymal, and diffuse alveolar septal variety (1) Surgical lung biopsy (SLB) is a standard diagnostic method for pulmonary amyloidosis. Recently, transbronchial lung cryo biopsy (TBLC) has high diagnostic yield for interstitial lung disease with lower post-procedural complications (2) We highlight a case here that used a similar technique to diagnose pulmonary amyloidosis. CASE PRESENTATION: A 73-year-old female with a past medical history of tobacco use (10-pack year, quit about 40 years ago), 6-month history of atrial fibrillation and sick sinus syndrome requiring pacemaker placement, and a 1-year history of carpal tunnel syndrome status post-surgical management, presented to the office with a 1-year history of exertional dyspnea, wheezing, and a persistent dry cough. Physical examination demonstrated only mild inspiratory crackles. Laboratory investigations revealed eosinophilia (112 cells/mm3), elevated C-reactive protein (14.6 mg/L), low serum immunoglobulin (Ig) levels of IgM and IgA, elevated serum IgG (1868 g/L) with predominant IgG class 1 elevation and lower levels of other IgG classes, and cytoplasmic pattern elevation of antinuclear antibody with titer of 1:320. On further serological workup, the patient was noted to have combined immunodeficiency and possible plasma cell dyscrasia. Pulmonary function testing showed mildly diminished diffusion consistent with a restrictive pattern. CT Chest revealed bilateral persistent pulmonary infiltrates. Patient then underwent bronchoscopy with transbronchial cryo biopsy obtained from the left lower lobe, and pathology illustrated lung parenchyma changes consistent with amyloidosis. Congo red stain for amyloid was positive. Immunostaining for CD138 and kappa and lambda ISH stains showed few plasma cells with kappa predominance suggestive of a monotypic kappa plasma cell population. Special stains for acid fast bacilli, pneumocystis and fungi were negative.Patient was referred to oncology and was found to have elevated B2 microglobulin, Kappa light chain and free kappa/lambda ratio. Carrying a unifying diagnosis of light chain amyloidosis explains many of her recent medical problems. DISCUSSION: Transbronchial lung cryo biopsy (TBLC) has recently been used to diagnose interstitial lung disease (ILD), but its diagnostic efficacy for pulmonary amyloidosis has not been validated. TBLC can obtain a larger pulmonary specimen for pulmonary amyloidosis than forceps biopsy, and it has fewer complications and a lower mortality rate than SLB. Cryobiopsy has been associated with a significant increase in the diagnostic rates of ILDs (3). Forceps biopsy (TBLB) via cryoprobe has been used for diagnosing ILD, but no comparison has been made in pulmonary amyloidosis cases for (TBLC vs TBLB). CONCLUSIONS: Compared to surgical lung biopsy (SLB), transbronchial lung cryo biopsy (TBLC) has the benefit of obtaining a larger pulmonary specimen for pulmonary amyloidosis, fewer complications, and a lower mortality rate. There remains potential for research in terms of deciding the efficacy of both techniques in diagnosing pulmonary amyloidosis. REFERENCE #1: Gandham, A. K., Gayathri, A., & Sundararajan, L. (2019). Pulmonary amyloidosis: A case series. Lung India: Official Organ of Indian Chest Society, 36(3), 229-232. https://doi.org/10.4103/lungindia.lungindia_205_18 REFERENCE #2: Fujimoto, K., Inomata, M., Ito, Y., Matsumoto, H., Saiki, A., Sakamoto, K., Awano, N., Kuse, N., Kumasaka, T., & Izumo, T. (2021). Pulmonary amyloidosis diagnosed via transbronchial lung cryo biopsy without surgical lung biopsy: A case series. Respiratory Medicine Case Reports, 38. https://doi.org/10.1016/j.rmcr.2022.101688 REFERENCE #3: Giri M, Huang G, Puri A, Zhuang R, Li Y, Guo S. Efficacy and Safety of Cryobiopsy vs. Forceps Biopsy for Interstitial Lung Diseases, Lung Tumors, and Peripheral Pulmonary Lesions: An Updated SystematicReview and Meta-Analysis. Front Med (Lausanne). 2022 Mar 10;9:840702. doi: 10.3389/fmed.2022.840702. PMID: 35372452; PMCID: PMC8965605. DISCLOSURES: No relevant relationships by Maimoona Iftikhar Ali No relevant relationships by Ibtisam Ashraf No relevant relationships by Hamza Atta Khan No relevant relationships by Mir Ali Asghar Shah No relevant relationships by Matthew Woodford" @default.
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• W4387248632 title "USE OF TRANSBRONCHIAL CRYOBIOPSY TO DIAGNOSE PULMONARY LIGHT CHAIN AMYLOIDOSIS: A NOVEL CASE" @default.
• W4387248632 doi "https://doi.org/10.1016/j.chest.2023.07.3649" @default.
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