Multiple Myeloma Coverage from Every Angle

Myelomatous Pleural Effusion at Time of Initial Diagnosis of Myeloma: Case Report

By: Joseph Fanelli
Posted: Thursday, March 26, 2020

Myelomatous pleural effusion was discovered at the initial diagnosis of multiple myeloma for a patient in Thailand and is described in detail in a case report presented in Respiratory Medicine Case Reports. The “rare clinical manifestation” of multiple myeloma had a positive response to initial dexamethasone without local therapy, concluded Wipa Reechaipichitkul, MD, of Khon Kaen University, Thailand, and colleagues.

“It is interesting to conduct the further study of cytogenetic subtype of [myelomatous pleural effusion] and [its] treatment responsiveness,” the authors said. “We hypothesize that our case may have favorable cytogenetic characterizations such as hyperdiploidy.”

In this case report, the authors described a 59-year-old man who was initially hospitalized for a 1-week progressive paraparesis. Physicians ultimately made the diagnosis of multiple myeloma with bilateral myelomatous pleural effusion and T6 spinal cord compression (International Staging System III, Durie-Salmon stage IIIB).

After initial therapy, the patient was treated with 40 mg/day of dexamethasone. A T6 laminectomy was performed, revealing greyish tumors in the laminar and pedicle cortexes. Spinal tissue from the patient showed myeloma with kappa light chain restriction. The immunohistochemistry tested positive for CD138 and kappa light chain, but negative for lambda light chain.

Following the operation, the patient’s “motor power” in his legs improved from grade 5 to grade 4. After 1 week of treatment with dexamethasone, chest radiographs displayed resolution of pleural effusion. The investigators found that serum creatinine and calcium levels were within normal limits. The patient was discharged after 3 weeks of admission and treated with a regimen of bortezomib, cyclophosphamide, and dexamethasone at an outpatient department.

Disclosure: The study authors reported no conflicts of interest.

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