Reactive plasmacytosis mimicking multiple myeloma associated with SFTS virus infection: a report of two cases and literature review

Abstract

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus named SFTS virus (SFTSV), which is classified into the genus Phlebovirus and family Phenuiviridae. Reactive plasmacytosis mimicking multiple myeloma is a very rare condition in association with SFTS. Here, we describe two SFTS cases who presented with hyperimmunoglobulinemia, as well as extensive bone marrow and peripheral blood plasmacytosis, which mimicked multiple myeloma (MM).

Case presentation: We report two cases who presented with fever and blood routine abnormity which were conformed as SFTS eventually. They were performed bone marrow aspiration and were admitted to the department of hematology with a preliminary diagnosis of MM. They all had hyperimmunoglobulinemia, extensive bone marrow and peripheral blood plasma cells, prolonged activated partial thromboplastin time (APTT), elevated hepatic enzyme. The two patients recovered with treatment of doxycycline, human immunoglobulins, plasma transfusion, and other supporting treatments. But case 1 occurred lymphoma 8 months later and died.

Conclusion: SFTS might be one of differential diagnosis of MM in certain endemic area. We also conclude that SFTSV is a pantropic virus that could injure most tissues and cells of the human body.

Keywords: Multiple myeloma; Reactive plasmacytosis; SFTS; Severe fever with thrombocytopenia syndrome.

Fig. 1

Representative images of bone marrow cytology(Wright and Giemsa stain) showing plasmacytosis. a For case 1, (b and c) for case 2 at different time points

Fig. 2

Representative scatter plots of bone marrow flow cytometric immunophenotyping. (a-c) For case 1, the incresed plasma cells were polyclonal (CD19 + CD38 + CD138 + cKappa+cLambda+) (d-f) for case 2, the incresed plasma cells were abnormal monoclonal (CD19 + CD38 + CD138 + cKappa-cLambda+) (g-i) for case 2, the incresed plasma cells disappear and were polyclonal (CD19 + CD38 + CD138 + cKappa+cLambda+)