Cutaneous and pleural involvement in a patient with multiple myeloma

Abstract

Multiple myeloma (MM) is a malignant proliferation of a single clone of plasma cells and an excess of monoclonal immunoglobulin production. It is rarely associated with cutaneous and pleural involvement. We report a new case of a 62-year-old woman with a history of a symptomatic MM. Three months after chemotherapy initiation, she presented with subcutaneous nodules. Ultrasound-guided needle biopsy confirmed the diagnosis of cutaneous plasmacytomas. She underwent local radiation therapy leading to complete regression of subcutaneous nodules. One month later, she developed dyspnoea. Thoracic CT scan showed pleural thickening associated with pleural effusion. Pleural biopsy confirmed the diagnosis of pleural plasmacytoma. Chemotherapy including vincristine, doxorubicin and dexamethasone was administered. Cutaneous involvement and pleural effusion accompanying MM are uncommon. They are associated with poor prognosis.

Recurrent Cutaneous Manifestation in Multiple Myeloma: A Case Report and Management Approach

“…Multiple lesion can be present at the same time (7). They are usually red, violaceous lesions characterized by a diameter of 1-5cm or more (9). Trauma might play a signi cant role in harboring plasma cells in skin nevertheless, in our patient's case there was no history of trauma or instrumentation.…”

Pleural plasmacytomas in a patient with multiple myeloma relapse

“…Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) allows the examination of the whole body in a single and faster study, and can help identify active disease in patients with relapsed or refractory MM by directly targeting the specific cellular properties of neoplastic plasma cells. This imaging technique has been found to offer superior detection of extramedullary disease, while providing important prognostic information [ [9] , [10] , [11] ]. Indeterminate pulmonary nodules or pleural lesions can be diagnosed by performing a transbronchial biopsy, CT-guided needle biopsy or a surgical biopsy through medical thoracoscopy, open thoracotomy or video-assisted thoracoscopic surgery (VATS).…”

Plasma cell infiltration of skin and pleural fluid: A case report on an unusual presentation of myeloma

“…Myeloma is rarely suspected from skin disorders but even in the patients with minimal systemic manifestations, the presenting feature of myeloma may be cutaneous lesions and hence clinical suspicion becomes necessary to diagnose the malignancy early [8] . Pleural effusions due to myelomatous involvement is rare in myeloma patients, occurring in about 6% of the cases [9] . Common causes of pleural effusions in myeloma include congestive heart failure due to hyperviscosity or amyloidosis, renal failure, pulmonary embolism due to a hypercoagulable state or plasma embolization, a secondary neoplasm, infections due to immunosuppression (pneumonia, tuberculosis, AIDS, other viral illnesses).…”

“…Common causes of pleural effusions in myeloma include congestive heart failure due to hyperviscosity or amyloidosis, renal failure, pulmonary embolism due to a hypercoagulable state or plasma embolization, a secondary neoplasm, infections due to immunosuppression (pneumonia, tuberculosis, AIDS, other viral illnesses). Affected patients are usually resistant to treatment and often relapse in spite of receiving appropriate chemotherapy [9] . The patients may show no respiratory symptoms or may have symptoms like dull chest pain, dyspnea, dry cough which are generally seen in pleural effusion [10] .…”

“…The treatment is generally based on IMWG 2014 guidelines. Regardless of the treatment, the prognosis in patients having cutaneous infiltration or pleural fluid effusion or both ~ 22 ~ together remains poor [9] . Supportive measures addressing bone disease and associated complications, anemia, organ failure etc.…”