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KMID : 0368120100400120671
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Korean Circulation Journal
2010 Volume.40 No. 12 p.671 ~ p.676
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A Case of Cardiac Amyloidosis With Diuretic-Refractory Pleural Effusions Treated With Bevacizumab
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Bae Suk-Hyang
Hwang Jin-Yeon
Kim Woo-Jae
Yoon Hyun-Hwa
Kim Jung-Min
Nam Young-Hee
Baek Hee-Gyung
Cho Yong-Rak
Park Sun-Yi
Kim Jeong-Hwan
Kim Sung-Hyun
Park Tae-Ho
Lee Gi-Nam
Rha Seo-Hee
Kim Young-Dae
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Abstract
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Cardiac amyloidosis describes a clinical disorder caused by infiltration of abnormal insoluble fibrils in the heart, characterized by progressive heart failure and a grave prognosis. Pleural effusion in cardiac amyloidosis may represent a sign of heart failure, but it can also result from pleural infiltration of amyloid, manifested by recurrent large fluid accumulations. Recently, the role of vascular endothelial growth factor (VEGF) has been implicated in the pathogenesis of refractory pleural effusion. We report a case of a 53 year-old female patient with cardiac amyloidosis who presented with recurrent accumulation of large pleural effusions. She was initially treated with high dose loop diuretics, but the pleural effusion persisted, with the daily amount of drainage averaging 1 L/day. Accumulation of pleural fluid did not subside after 3 cycles of melphalan/prednisolone therapy. After the introduction of bevacizumab, an anti-VEGF antibody, the amount of pleural effusion decreased significantly. Efficacy of anti-VEGF therapy for refractory pleural effusions needs to be defined through further studies.
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KEYWORD
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Heart disease, Amyloidosis, Pleural effusion, Bevacizumab
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