A case of cardiac amyloidosis with diuretic-refractory pleural effusions treated with bevacizumab

• Published in: Korean circulation journal Vol. 40; no. 12; pp. 671 - 676
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Cardiology 01.12.2010; 대한심장학회
• Subjects: Case Report; 내과학; Pleural effusion; Amyloidosis; Heart disease; Bevacizumab
• ISSN: 1738-5520; 1738-5555
• DOI: 10.4070/kcj.2010.40.12.671

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.