SESSION TITLE: Pulmonary Manifestations of Systemic Disease Student/Resident Case Report Posters II
SESSION TYPE: Student/Resident Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Pleural effusions in multiple myeloma are rare and usually secondary to other processes such as infections. Primary Myelomatous Pleural Effusions (MPE) are extremely rare, most commonly associated with IgG subtype. We present a case of IgA MPE.
CASE PRESENTATION: Forty-year male with advanced IgA Multiple Myeloma (MM) characterized by poor prognostic markers (Monosomy 13, trisomy 9 and IgH rearrangement) was admitted with dyspnea. He had failed multiple lines of chemotherapy and his disease was complicated by pancytopenia and chronic renal failure. CT chest revealed crazy paving pattern with minimal effusion on admission. Bronchoscopy samples were negative for infection, Periodic Acid Schiff and Congo Red staining. He developed rapidly progressive respiratory failure with a re-accumulating right pleural effusion. Thoracentesis yielded an exudative effusion with negative microbiology studies. The cytology was positive for CD138 positive atypical plasma cell proliferation, consistent with plasma cell dyscrasia as well as positive IgA monoclonal protein. His respiratory failure worsened, he was intubated and the family is deliberating withdrawal of care.
DISCUSSION: This unfortunate patient was unique in that he not only developed multiple myeloma at a young age but his disease was complicated by rare manifestation of MPE. Pleural effusion from all causes occurs only in 6% of MM cases. MPE occur in less than 1% MM and remains a diagnosis of exclusion. Our patient’s MPE was due to refractory disseminated multiple myeloma. He had failed several salvage chemotherapy regimens. MPE has no clearly defined risk factors and IgG type seems the most common subtype associated with MPE, making this case even more rare. MPE carries a very poor prognosis, with median survival of 4 months.
CONCLUSIONS: Development of pleural effusions in MM patients should always raise the suspicion for MPE, particularly when other common causes are ruled out.
Reference #1: Al-Farsi K, Al-Haddabi I, et al. Myelomatous Pleural Effusion: Case report and review of the literature. Sultan Qaboos University Medical Journal. 2011;11(2):259-264.
Reference #2: Rodriguez JN, Pereira A et al. Pleural effusion in multiple myeloma. Chest 1994;105:622-4.
DISCLOSURE: The following authors have nothing to disclose: Guido Barmaimon, Pius Ochieng, Gopal Narayanswami
No Product/Research Disclosure Information