A case of bilateral pleural effusion as the first sign of multiple myeloma

European Journal of Medical Research

Jian-ying Zhou¹  Qian Shen¹  Yi-hong Shen¹  Xuan-li Xu¹ 

[1] Department of Respiratory Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China

关键词: Pleural effusion;    Multiple myeloma;   

Others  :  820172
DOI  :  10.1186/2047-783X-18-7

 received in 2012-10-09, accepted in 2013-02-28,  发布年份 2013

【 摘 要 】

Multiple myeloma (MM) is a type of hematological malignancy that can affect all types of tissues in human. However, it is extremely rare that pleural effusion presents as the first sign in MM patients. A 54-year-old male patient attended our department of respiratory medicine complaining of shortness of breath for the past 3 months. A chest computer tomography (CT) radiograph revealed a bilateral pleural effusion, which was further assessed as exudative type. Sinus spiral CT scan demonstrated diffuse bone destruction of craniofacial bone. A broad reduction of the lumbar bone signal was confirmed by MRI. Furthermore, pleural biopsy showed abnormal proliferation of plasmocytes whereas bone marrow biopsy showed active hyperplasia of plasmacytoid cells. Interestingly, Bence-Jones protein in urine and serum protein electrophoresis was negative. The patient was diagnosed as non-secretory MM. He then underwent chemotherapy with vincristine, adriamycin and dexamethasone. Partial regression of the pleural effusion was achieved after two rounds of chemotherapy, and the patient has been followed for more than one year.

【 授权许可】

   
2013 Xu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Kumar SK, Mikhael JR, Buadi FK, Dingli D, Dispenzieri A, Fonseca R: Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines. Mayo ClinProc 2009, 84:1095-1110.
• [2]Elloumi M, Frikha M, Masmoudi H, Mseddi S, Ben Ayed M, Bouaziz M: Plasmocytic pleural effusion disclosing multiple myeloma. Rev Mal Respir 2000, 17:495-497.
• [3]Sasser RL, Yam LT, Li CY: Myeloma with involvement of the serous cavities. Cytologic and immunochemical diagnosis and literature review. Acta Cytol 1990, 34:479-485.
• [4]Dhingra KK, Singhal N, Nigam S, Jain S: Unsuspected multiples myeloma presenting as bilateral pleural effusion - a cytological diagnosis. Cytojournal 2007, 4:17.
• [5]Makino S, Yamahara S, Nagake Y, Kamura J: Bence-Jones myeloma with pleural effusion: response to alpha-interferon and combined chemotherapy. Intern Med 1992, 31:617-621.
• [6]Kintzer JS, Rosenow EC, Kyle RA: Thoracic and pulmonary abnormalities in multiple myeloma: A review of 958 cases. Arch Intern Med 1978, 138:727-730.
• [7]Buyukberber M, Sevinc A, Cagliyan CE, Gulsen MT, Sari I, Camci C: Non-Hodgkin lymphoma with high adenosine deaminase levels mimicking peritoneal tuberculosis: an unusual presentation. Leuk Lymphoma 2006, 47:565-568.
• [8]Aghaei M, Karami-Tehrani F, Salami S, Atri M: Adenosine deaminase activity in the serum and malignant tumors of breast cancer: the assessment of isoenzyme ADA1 and ADA2 activities. ClinBiochem 2005, 38:887-891.
• [9]Yokoyama T, Tanaka A, Kato S, Aizawa H: Multiple myeloma presenting initially with pleural effusion and a unique paraspinal tumor in the thorax. Intern Med 2008, 47:1917-1920.