Pleural effusion as a manifestation of multiple myeloma

Abstract

Multiple myeloma is a clonal B-cell malignancy, characterised by proliferation of plasma cells and secretion of paraproteins. These plasma cells accumulate predominantly in the bone marrow; rarely, they invade other areas, especially the thorax. Myeloma presenting with a pleural effusion is rare and reported in only 6% of patients with myeloma. Such patients generally present late and have a poor prognosis. Here, we describe a patient presenting with a lung mass, renal failure and a massive unilateral pleural effusion due to multiple myeloma who was treated successfully.

Figure 1

Chest X-ray showing right-sided effusion with mediastinal shifting. Lytic lesion visible on clavicles.

Figure 2

CT scan chest mediastinal window showing a mass causing erosion of right rib with underlying effusion.

Figure 3

(A) High-power view of sheets of atypical plasmacytoid cells. (H&E stain, ×400 magnification). (B) Immunohistochemical expression for (a) Mum-1, (b) CD138 and (c) CD56.

Figure 4

Chest X-ray at the time of discharge.