Pulmonary Amyloidosis with Multiple Cystic Lesions with Central Calcifications

A non-smoker 80-year old woman with a past medical history of inactive and untreated systemic lupus erythematous diagnosed in 1983 and polymyalgia rheumatica treated with prednisone (3 mg once daily) since 2018, was referred to our emergency department because of left-sided chest pain and dyspnoea. She presented no cough, weight loss or fever and there was no history of Sjogren’s syndrome. Complete blood count was unremarkable and no inflammatory syndrome was observed. A chest CT-scan revealed multiple diffuse cystic parenchymal lesions with thin walls and central nodular calcifications in both lungs (Figure 1A). The sputum culture was negative for mycobacterium tuberculosis, legionella pneumophilia, mycoplasma pneumonia, chlamydia pneumonia, coronavirus, echinococcosis and aspergillus. Anti-Nuclear Antibody (ANA) and anti-Ku tests were positive whereas anti-neutrophil cytoplasmic antibody (ANCA) and anti-nucleoprotein tests were negative. The preoperative pulmonary function tests showed a FEV1 of 78% and a DLCO of 73% of the predicted values.