Multiple myeloma causing interstitial pulmonary infiltrates and soft-tissue plasmacytoma

Abstract

Multiple Myeloma (MM) is a relatively rare disease and MM presenting outside the bone marrow, known as extramedullary myeloma (EMM), is rarer still. While the liver and CNS are most commonly affected in EMM, the lung parenchyma is an especially unusual site of involvement.We present the case of a 64-year-old male with known history of MM admitted with acute respiratory failure and a chest wall mass. Chest CT revealed patchy interstitial and alveolar opacities with no pulmonary masses or nodules. Bronchoalveolar lavage (BAL) was performed, with flow cytometry demonstrating monoclonal plasma cells expressing CD38, CD138 and CD56 with lambda light chain restriction. Fine Needle Aspiration of chest wall mass revealed CD138-positive cells as well.Review of the literature revealed only one other documented case of a patient presenting with both interstitial lung parenchymal involvement with MM as well as soft tissue plasmacytoma, with this occurring in a patient who had previously underwent stem cell transplant. To our knowledge, we report the first recorded case of this presentation in a patient without a history of stem cell transplantation. Furthermore, it demonstrates the utility of using BAL, rather than lung biopsy, to establish the diagnosis through less invasive means.

Rare case of plasmablastic myeloma diagnosed on lung biopsy

“…Extramedullary plasmacytoma involving the paraspinal soft-tissue is not uncommon, but an SEP in the orbit is a rare presentation with only a handful of cases recorded in the scientific literature. 5 12 In our case, the patient had proptosis and blurred vision. This needed aggressive management with radiotherapy to avoid loss of vision.…”

Paraskeletal plasmacytoma presenting as a chest wall mass

“…The CT scan of the thorax usually reveals soft tissue density lesions that may involve the ribs. The confirmatory diagnosis of plasmacytoma is made based on fine needle aspiration, image-guided biopsy or incisional biopsy of the mass [11][12][13][14].…”

What the Intensivists Need to Know About Critically Ill Myeloma Patients

“…Myeloma lung: Case reports and case series describe the various ways MM can involve the lung. Presentation of lung disease is variable and includes consolidative or interstitial pattern infiltrates on imaging, intraparenchymal plasmacytomas, intrapulmonary calcifications, or pleural effusions [60,73,139]. Presentations similar to ARDS have also been reported [40,80,99,106,134].…”