A 58-year-old man was admitted complaining of hemoptysis and dyspnea. Chest roentgenogram demonstrated bilateral alveolar infiltrates in the middle and lower lung fields. Diffuse alveolar filling shadows were seen on standard chest CT images. His symptoms and pulmonary infiltrates gradually resolved after administration of high-dose corticosteroids and erythromycin. Immunoelectrophoresis showed increased IgM of lambda type. Transbronchial lung biopsy specimens revealed amyloid deposits in the alveolar septa and blood vessel walls. Cervical lymph node biopsy specimen also showed amyloid deposits. The amyloid in this case stained positively with anti-A lambda type amyloid antibody. A diagnosis of primary systemic amyloidosis was made.
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