Pseudotumoral tracheobronchial amyloidosis mimicking asthma: a case report

Abstract

IntroductionTracheobronchial amyloidosis is an uncommon localized form of amyloidosis that can simulate a tracheal tumor. Clinical signs are not specific and the diagnosis is rarely given before performing a bronchoscopy with multiples biopsies.Case presentationWe report the case of a 60-year-old Moroccan woman, complaining of dyspnea and wheezing for three years, who was treated at our institution for management of severe asthma. A bronchoscopy revealed a tumor formation of her trachea; multiples biopsies were performed and a diagnosis made of amyloid light-chain amyloidosis. She successfully received an endoscopic resection.ConclusionThis case highlights the importance of routinely carrying out an endoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma. Tracheal amyloidosis is a rare disease, confirmed by histological examination of bronchial biopsies, and the treatment of choice is based on the bronchoscopic resection.

A Case of Tracheal Amyloidosis Admitted with Rectus Abdominis Muscle Hematoma

“…Three forms of localized amyloidosis were seen in respiratory system; 1) nodular opacities, 2) diffuse opacities, 3) and tracheobronchial disease (2). The deposition of amyloid material as submucosal plaques and/or polypoid tumours is characteristic in tracheobronchial amyloidosis (3).…”

“…The cases present with cough, dyspnoea or haemoptysis and may be asymptomatic (1). The symptoms can mimic respiratory conditions such as asthma (3,4). Severe cough can be associated with many complications and one of these complications is muscle haematoma.…”

Tracheobronchial Amyloidosis Mimicking Tracheal Tumor

“…The most cases of respiratory amyloidosis have been described in three forms: diffuse interstitial amyloidosis, nodular parenchymal amyloidosis, and tracheobronchial amyloidosis [3]. With only around one hundred cases reported in the literature, tracheobronchial amyloidosis is a rare form of localized amyloidosis [4]. …”

Primary tracheobronchial amyloidosis

“…Clinically, amyloidosis-related tracheobronchial impairment can be asymptomatic or can manifest as dyspnea, wheezing, hemoptysis, cough, or recurrent pneumonia ( 4 , 5 ) . The symptoms can be similar to those of bronchial diseases that are more common, including bronchial asthma ( 5 ) .…”

“…In individuals with amyloidosis, bronchoscopy usually shows thickening of the walls of the trachea and bronchi, with flat, multifocal, grayish-yellow plaques in the trachea and bronchi. In rare cases, amyloid pseudotumors can be seen ( 5 , 13 ) . Histopathological findings of the disease include amyloid thickening of the submucosa, in nodular masses or laminae, showing apple-green birefringence after staining with Congo red ( 14 ) .…”