IgD myeloma indicated by plasma cells in the peripheral blood and massive pleural effusion

Abstract

Dear Editor, Multiple myeloma, a B-cell malignancy characterized by clonal proliferation of plasma cells in the bone marrow, has been associated with unique clinicopathologic features, genetic abnormalities, and response to therapy [1][2][3]. Immunoglobulin D (IgD) myeloma is a rare disease, accounting for about 2% of all myelomas. Pleural effusions occur in 6% of myeloma patients. The etiology is multifactorial and effusions due to pleural myelomatous involvement are rare, occurring in <1% of the cases [4].We experienced a patient with IgD 1 multiple myeloma, which was first indicated by plasma cells in the peripheral blood. Furthermore, cytogenetic study of the pleural effusion revealed several abnormalities. We reviewed the clinical and cytogenetic features of this case and report the findings in detail.An 82-year-old man was admitted to our hospital in February 2002 with the chief complaint of dyspnea on effort and arrhythmia. His medical history included myocardial infarction in 1991. Chest X-ray results showed cardiomegaly and bilateral pleural effusion. He was diagnosed with acute heart failure as a result of previous myocardial infarction. The administration of diuretics and an antiarrhythmic resulted in a rapid improvement. However, the recovery did not last; the pleural effusion slowly increased and diuretics were ineffective. Moderate anemia worsened and transfusion was necessary. Hematological examination revealed plasma cells in the peripheral blood and a hematologist was consulted. On physical examination, there was anemia in the connective pulp, and heart sounds showed a systolic murmur. There was a decrease in breath sounds at the base of both lungs. Bilateral presidiapitting edema was evident. Hematological examination revealed anemia (hemoglobin 7.7 g/dl) with plasma cells in the peripheral blood (18%). Total serum protein was 6.0 g/dl with 64.9% albumin and 14.5% γ-globulin. Creatinine 1.35 mg/dl, blood urea nitrogen 27 mg/dl, uric acid 13.3 mg/dl, and lactate dehydrogenase 679 IU/L (reference range 230-460). Immunoelectrophoresis showed monoclonal IgD (λ) in the serum and Bence Jones protein (1) in the urine. Quantitative immunoglobulin determination showed a marked increase in IgD, 934 mg/dl, while IgG, IgA and IgM levels were decreased (Table 1). Bone marrow aspiration resulted in dry tap and biopsy results showed multiple myeloma. Chest X-ray results showed bilateral pleural effusion, whereas X-ray examination of the rest of the body was normal. Echocardiography results did not indicate amyloid deposition in the myocardium, but the ejection fraction was decreased because of a previous myocardial infarction.The patient also underwent thoracentesis. Cytological examination of the pleural effusion showed numerous plasma cells. There were two sizes of atypical plasma cells: small, round-shaped, mature plasma cells, and large, round-shaped, immature plasma cells. Clusters of differentiation 38 (CD38) and CD138 surface markers were investigated in the pleural effusion and found to be positive in...

Pleural Effusion in a Patient with Multiple Myeloma

“…Areas other than bone marrow may be invaded as well, particularly the thorax. Pleural effusion, which may be a marker of thoracic involvement, affects about 6% of patients with MM (2,3 ).…”

“…Areas other than bone marrow may be invaded as well, particularly the thorax. Pleural effusion, which may be a marker of thoracic involvement, affects about 6% of patients with MM (2,3 ).A wide range of etiologic factors may cause pleural effusion in MM (Table 1) (2, 4-7); however, actual myelomatous pleural effusions are very uncommon, with fewer than 100 cases having been reported worldwide (8,9 ). The most common causes of pleural effusion associated with MM are heart failure, renal failure, effusions related to pneumonia, and amyloidosis.…”

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Multiple Myeloma with Pleural Effusion According to Initial Findings

“…Pleural effusion occurs in approximately 6% of MM patients. [5] MM mainly affects bone marrow cells. But in rare cases, the first finding is pleural effusion.…”