PMC7155221_01
Chest CT showed left lower lung accentuated consolidation with a widening of interlobular septa and pleural effusion.
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The imaging suggested interstitial edema (Fig. 1).
Transbronchial biopsy Occasional alveolar macrophages loaded with eosinophilic intracytoplasmic granular amorphous material (A). This material was highlighted by DFS stain (B), but not with DFS-KMnO4 stain (C). Reactivity with anti-amyloid A immunostaining confirmed the diagnosis of systemic AA amyloidosis (D).. Hematoxylin (A), DFS (B), DFS-KMnO4 (C), Amyloid A (D); x 600.
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Although no obvious findings of amyloid deposition found in the lung parenchyma, alveolar macrophages showed enlarged cytoplasm containing granular intracytoplasmic material (Fig. 2A). The material was positive with DFS stain (Fig. 2B) and anti-amyloid A immunostaining (Fig. 2D), but negative with KMnO4-DFS stain (Fig. 2C).
Cytology of bronchoalveolar lavage Several macrophages containing intracytoplasmic material are observed (A). This material is highlighted by DFS stain (B) and amyloid A immunostain (C).. Pap stain (A), DFS (B), Amyloid A (C); x 400.
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Similar macrophages were also found in the bronchoalveolar lavage fluid (Fig. 3A-C).