Harsh Patel: Department of Family Medicine, Central Jersey Urgent Care, Green Brook, NJ 08812, USA.
Aaiyat Sheikh: Era's Lucknow Medical College, Lucknow, Uttar Pradesh 226003, India.
Gnana Deepthi Medarametla: NRI Medical College and General Hospital, Guntur, Andhra Pradesh 522503, India.
Sri Abirami Selvam: Department of Internal Medicine, St Mary Medical Center, Langhorne, PA 19047, USA.
Syed Nazeer Mahmood: Department of Medicine, Section of Pulmonary/Critical Care, MedStar Washington Hospital Center, Washington, DC 20770, USA.
Gurleen Johal: Department of Medicine, Hackensack Meridian Palisades Medical Center, North Bergen, NJ 07047, USA.
Janani Arunachalam: Department of Biomedical Engineering, University of Houston, Houston, TX 77021, USA.
Haripriya Radhakrishnan: Shimoga Institute of Medical Sciences, Shimoga, Karnataka 577201, India.
Viray Shah: Department of Hospital Medicine, Medstar Good Samaritan Hospital, Baltimore, MD 21239, USA.
Aditya Lal Vallath: Department of Emergency Medicine, Peerless Hospital and BK Roy Research Center, Kolkata, West Bengal 700094, India.
Digantkumar Patel: Springfield Memorial Hospital, Springfield, IL 62781, USA.
Saketh Palasamudram Shekar: Interventional Pulmonology, Department of Pulmonary and Critical care Medicine, Pulmonary and Sleep Associates of Huntsville, Huntsville Hospital, Huntsville, AL 35801, USA.
Urvish Patel: Department of Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Nisarg Changawala: The Lung Center of Nevada, Las Vegas, NV 89138, USA.
B-cell lymphoproliferative disorders are characterized by the accumulation of mature B lymphocytes in the bone marrow, lymphoid tissues, and/or peripheral blood. They can cause amyloid deposits in the lungs. In rare cases, lung nodules can be the first sign of this disorder. We present the case of an 89-year-old woman with stable shortness of breath and lung nodules on imaging. A positron emission tomography-computed tomography (PET-CT) scan showed the most intense hypermetabolic nodule in the patient's lung, which was 1.5 × 1.4 cm. A biopsy of this nodule showed amyloid material with trapped plasma cell infiltrate on microscopy. Congo red stain under polarizing microscopy showed apple-green birefringence, which is diagnostic for amyloidosis. Immunohistochemistry showed a mixture of kappa-positive and lambda-positive cells. B-cell gene rearrangement-clonal gene rearrangements were detected in the immunoglobulin heavy chain (IgH) gene and the kappa light chain (IGK). These findings suggest a B-cell lymphoproliferative disorder, such as a plasmacytoma or a marginal cell lymphoma with plasma cell differentiation. The patient was diagnosed with a B-cell lymphoproliferative disorder and pulmonary amyloidosis. Isolated amyloidosis in the lungs usually has a good prognosis, but it can be a sign of autoimmune diseases or B-cell lymphoproliferative disorders, as in this case. Early diagnosis of B-cell lymphoproliferative disorder can lead to successful treatment and prevents complications.
