An unusual cause of haemoptysis: isolated tracheobronchial amyloidosis.

To cite: Zalewska KI, Brown A, McKeon DJ. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014205118 DESCRIPTION A 64-year-old woman presented with chest pain, wheeze and haemoptysis. She had a history of previous pulmonary embolism (PE) and Sjögrens syndrome. A chest radiograph was unremarkable. CT pulmonary angiogram (CTPA) showed no evidence of PE; however, a mass was noted in the left lower lobe extending to the left hilum (figure 1). Bronchoscopic examination demonstrated inflamed, friable mucosa in this area (figure 2) but no endobronchial lesion. Biopsies from this area showed fibrosis and deposition of eosinophilic amorphous material that was positive for Congo Red staining with an apple green birefringence. The deposits stained specifically with antibodies against λ light-chains, confirming the presence of amyloid light-chain (AL) amyloidosis in the bronchial mucosa. Clinical evaluation, serum amyloid P component (SAP) scintigraphy and echocardiography did not show amyloid deposition in other organs, confirming isolated tracheobronchial amyloidosis. Further investigation for monoclonal plasma cell dyscrasia was negative. Learning points