Acute kidney failure and extramedullary lung infiltration as initial presentation of multiple myeloma - case report

Abstract

Introduction. Kidney failure in multiple myeloma is sometimes an initial symptomatology and a very serious complication with an unfavorable effect on the course and prognosis of the disease. Multiple myeloma is a disease characterized by proliferation of plasmocytes in the bone marrow, and in rare cases it can be extramedullary in various organs and systems. Pulmonary plasmacytoma localization is a rare extramedullary localization, especially when it represents one of the initial manifestations of multiple myeloma. Case report. We present a patient with a progression of acute kidney failure where hemodialysis treatment started. On the chest radiography, a homogeneous shadow was observed along the left chest wall, and MSCT pointed to the tumor formation in the pulmonary parenchyma in the projection of the left upper pulmonary lobe with signs of pleural infiltration, intercostal muscles and V rib destruction. Laboratory examination indicated presence of Bence -Jones proteinuria in the urine sample in addition to anemia syndrome and azotemia with hyperuricemia. After bronchoscopy and needle biopsy, diffuse infiltration of mature plasma cells was demonstrated in the cytological and pathohistological findings of the lungs. The pathohistological finding of bone marrow biopsy indicated multiple myeloma -Lambda type with infiltration of plasma cells -about 70%. Hematologist determined a diagnosis of multiple myeloma BJ lambda III BCS, with extramedullary lung infiltration and acute kidney failure. Further treatment was continued according to the hematological protocol while performing intermittent hemodialysis.Conclusion. Sometimes, extremely rarely, and in completely asymptomatic patients with massive pulmonary infiltration observed initially, differential diagnosis may also represent an extramedullary presentation of a multiple myeloma, which should be considered.