Pleural Effusion – Presenting Sign in Multiple Myeloma

Abstract

A patient with multiple myeloma in whom recurrent right pleural effusion was the presenting sign of the disease is reported. An IgA (k) monoclonal component was found in both the pleural effusion and the serum. The bone marrow specimen was interpreted as typical for multiple myeloma and the pleural fluid contained numerous plasma cells. Treatment with cyclophosphamide was followed by clinical improvement and the disappearance of the pleural effusion. The clinical picture of symptomatic multiple myeloma (MM) is dominated by signs and symptoms attributed to bone marrow infiltration by the neoplastic cells and bone destruction [1]. Extraosseous involvement in MM is uncommon and pleural involvement is even more rare [2–4]. We describe a patient with MM in whom the presenting sign of the disease was a recurrent right pleural effusion which disappeared following treatment with cyclophosphamide.

Multiple myeloma presenting as eosinophilic pleural effusion

“…MM is a rare neoplastic disorder caused by the proliferation of transformed B lymphoid progenitor cells, which results in a malignant clone of Ig-secreting plasma that affects all tissues, except reticuloendothelial tissues, and seldom causes a myelomatous pleural effusion. 6 A pleural effusion occurs in approximately 6% of patients with MM during the course of the disease 1,7 and not as a presenting sign. Pleural effusions in MM occur due to several etiologies requiring different types of therapy.…”

Pleural Immunocytoma with Waldenström’s Macroglobulinemia

“…The po lymorphism of this disease and the various visceral lesions are well known. Pleural ef fusion, as presenting sign is uncommon, dif ficult to diagnose as for all the pleural mani festations of hematological diseases [2], We report on such a case.…”

Bilateral Pleural Effusions due to Pulmonary Amyloidosis as the Presenting Manifestation of Multiple Myeloma

“…Though a pleural effusion occurs in approximately 6% of patients with Multiple Myeloma (MM) during the course of the disease, it is not usually a presenting sign 1,2. We present a case of a 69-year-old Caucasian man who presented with intractable bilateral pleural effusions for 2 years without a clear etiology despite extensive work up at other centers.…”