Silent Struggles: Tackling Recurrent Pleural Effusions in Primary Pulmonary Amyloidosis

Background: Recurrent pleural effusions occurring in association with immunoglobulin light chain (AL) amyloidosis, particularly without amyloid cardiomyopathy, are rare and typically indicate a poor prognosis.The mean survival time for these patients is approximately 1.6 months.Effective treatment strategies are not well established.Methods: We report a case involving a 60-year-old female presenting with recurrent pleural effusions.Comprehensive diagnostic evaluations, including imaging, pleural fluid analysis, and biopsy, were performed to determine the underlying cause.Following diagnosis, the patient was treated with a combination therapy consisting of Cyclophosphamide, Bortezomib, and Dexamethasone. Results: The patient was diagnosed with pulmonary amyloidosis associated with plasma cell myeloma. Upon initiation of the Cyclophosphamide-Bortezomib-Dexamethasone regimen, the patient exhibited significant clinical improvement. During the four-month follow-up period, she experienced no further hospitalizations or recurrences of pleural effusion. Conclusion: Recurrent pleural effusions in the context of AL amyloidosis without cardiomyopathy present a significant treatment challenge. This case demonstrates that a regimen of Cyclophosphamide, Bortezomib, and Dexamethasone can be effective, as evidenced by the patient's positive response and lack of effusion recurrence over four months.Further studies are needed to establish optimal treatment protocols.