Organizing Pneumonia in a Patient with Pulmonary Transthyretin Amyloidosis

Our plain-English summary of Organizing Pneumonia in a Patient with Pulmonary Transthyretin Amyloidosis, by Y. Tojo, Z. Watanuki, J. Sakurada, et al (Internal Medicine, 2026).

The study

• Authors: Y. Tojo, Z. Watanuki, J. Sakurada, T. Satoh
• Journal: Internal Medicine
• Published: 2026;65(18):2459-2464
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

An 86-year-old man who was a retired tunnel construction worker with pleural plaques and chronic pleural effusion was referred for an evaluation of newly developed pulmonary infiltrates. A transbronchial lung biopsy revealed organizing pneumonia with transthyretin amyloid deposition in the alveolar septa. Genetic testing confirmed wild-type transthyretin amyloidosis. Corticosteroid therapy led to partial resolution of the pulmonary infiltrates. Few cases of pulmonary transthyretin amyloidosis associated with organizing pneumonia have been reported. This case highlights the potential involvement of transthyretin amyloidosis in the development of organizing pneumonia.

In plain English

This case report described one 86-year-old Japanese man. He was a lifelong non-smoker and retired tunnel construction worker with 20 years of occupational asbestos exposure without respiratory protection. He had bilateral pleural plaques and a long-standing left-sided pleural effusion that the authors suspected was a benign asbestosis-related effusion. He presented with worsening breathlessness and a growing right lower lung shadow. A lung biopsy showed organizing pneumonia with transthyretin amyloid deposits, plus dust particles assumed to be crystalline silica. Genetic testing found no transthyretin gene mutation. He was diagnosed with wild-type transthyretin amyloidosis, organizing pneumonia and pneumoconiosis. Corticosteroids improved his symptoms and partly cleared the lung shadows; the pleural effusion did not change. Heart imaging supported a diagnosis of preclinical cardiac amyloidosis; he later developed atrial fibrillation and heart failure. To the authors' knowledge, only four cases of pulmonary wild-type transthyretin amyloidosis with organizing pneumonia had been reported, including this one. The authors suggested a possible relationship between asbestos exposure and transthyretin amyloidosis. They noted that one case report made it difficult to conclude whether the lung amyloidosis contributed to the organizing pneumonia.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 86-year-old Japanese man seen at South Miyagi Medical Center, Japan; a retired tunnel construction worker and lifelong non-smoker
• Exposure: 20 years of occupational asbestos exposure during tunnel construction without respiratory protection; the authors also describe occupational exposure to silica. No asbestos fiber type is named.
• Main results:
  • The chronic left-sided pleural effusion was suspected to be an asbestosis-related benign pleural effusion
  • The lung biopsy showed dust particles that were assumed to be crystalline silica
  • DNA analysis found no transthyretin gene mutation
  • The patient was diagnosed with wild-type transthyretin (ATTRwt) amyloidosis, organizing pneumonia and pneumoconiosis
  • Corticosteroids improved respiratory symptoms and partly cleared the consolidation; the pleural effusion was unchanged
  • The patient was diagnosed with preclinical cardiac ATTRwt amyloidosis
  • The patient later developed atrial fibrillation and symptomatic heart failure (two months after the diagnosis)
  • According to the authors, only four cases of pulmonary ATTRwt amyloidosis complicated by organizing pneumonia, including this one, had been reported
  • The authors regarded the patient's pleural plaques as indirect evidence of low-dose asbestos exposure
• The authors' conclusion: The authors concluded that corticosteroid-responsive lung involvement may present as organizing pneumonia in patients with ATTR amyloidosis. They also stated that this case indicates a possible relationship between asbestos exposure and ATTR amyloidosis.
• Limitations the authors state:
  • As a single case report, it is difficult to draw conclusions about whether pulmonary ATTR amyloidosis contributes to organizing pneumonia; further studies are needed
  • The FDG uptake in the lymph nodes was attributed to pneumoconiosis without histological confirmation

Topics

Medical terms in this study, explained in our Lexicon: Pleural Plaques, Pleural Effusion, Biopsy, Deposition.

Related studies

• Life after acute fibrinous and organizing pneumonia: a case report of a patient 30 months after diagnosis and review of the literature — C. Kuza, T. Matheos, et al. (2016)
• Nodular pulmonary amyloidosis associated with asbestos exposure — K. Hiroshima, H. Ohwada, et al. (1996)
• Usual interstitial pneumonia in asbestos-exposed cohorts - concurrent idiopathic pulmonary fibrosis or atypical asbestosis? — R.L. Attanoos, F.S. Alchami, et al. (2016)
• Cryptococcus pneumonia presenting in an immunocompetent host with pulmonary asbestosis: a case report — J.P. Guy, S. Raza, et al. (2012)
• Rounded atelectasis complicated by obstructive pneumonia and pulmonary arterial thrombosis — C.H. Chen, L. Newman (1990)
• Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases — R. Shibata, T. Ozaki, et al. (2020)

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