Anne-Marie Ionescu
George Eliot Hospital, Nuneaton
Title: Haemoptysis and a Purpuric Rash: A Rare Presentation of Amyloidosis
Submitted Date: 21-7-2016
Biography
Dr Ionescu has qualified from University college London (UCL) medical school in 2015 with a BSc and MBBS. \r\nDr O\'Brien is a Consultant Respiratory physician and qualified from the University of Hamburg in 1988 and completed her specialist training in 2000. She has developed a COPD early discharge service, a non-invasive ventilation service for exacerbations of COPD and the ambulatory care unit. Dr O\'Brien set up the interstitial lung disease board across the county. She is also a member of the the British Thoracic Society and a Fellow of the Royal College of Physicians.\r\n
Abstract
A middle aged man was admitted with a 2-3 year history of recurrent haemoptysis on exertion, culminating in a requirement for home oxygen therapy. On examination, he had a diffuse purpuric rash, subconjunctival haemorrhages, oral ulcers, macroglossia and dystrophic nails. He was initially investigated for Connective Tissue Disease (CTD) as a cause of HRCT-demonstrated lung fibrosis. However, further investigations found a lambda light-chain band on electrophoresis and a plasma cell dyscrasia on flow cytometry. Serum amyloid protein (SAP) scan, dermatological biopsy and bone marrow biopsy confirmed primary systemic amyloidosis secondary to multiple myeloma. It is believed that the cause of his haemoptysis is amyloid deposition in the lungs, though the SAP scan and CT report did not confirm this. His cause of haemoptysis remained controversial, though the clinical picture was one of amyloidosis. He underwent chemotherapy and clinically improved with no further reports of haemoptysis, resolution of his dermatological features and now he no longer requires home oxygen. \r\nOur aim is to promote the consideration of other potential causes of haemoptysis when in contjunction with other systemic features of diease. We also aim to elaborate on our case’s recovery of his respiratory symptoms when the haematolgical diagnosis had been targeted with relveant chemotherapy.\r\n