SHM Converge Scientific Abstract ePoster Gallery-Myelomatous Pleural Effusion: A Poor Prognosis Feature of Multiple Myeloma

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This case report describes myelomatous pleural effusion (MPE), a rare but serious complication of multiple myeloma. Multiple myeloma accounts for about 10% of hematologic malignancies and is classically associated with CRAB features: hypercalcemia, renal failure, anemia, and lytic bone disease. Although pleural effusions occur in about 6% of patients with multiple myeloma, true MPE is uncommon, occurring in less than 1% of cases, and is associated with a very poor prognosis, with a median survival of roughly 4 months.<br /><br />The report presents a 73-year-old woman with IgG lambda multiple myeloma diagnosed 2.5 years earlier who came to the emergency department with three weeks of worsening shortness of breath, fatigue, and poor appetite. She was hypoxic, requiring supplemental oxygen. Chest imaging showed a large left pleural effusion, and CTA ruled out pulmonary embolism. Thoracentesis and chest tube placement drained bloody-brown exudative fluid. Cytology demonstrated lambda-restricted plasma cells, confirming MPE.<br /><br />The patient was managed with hematology-oncology consultation and continued chemotherapy, as she wished to attend an upcoming family event. Her chest tube output gradually decreased and it was removed prior to discharge. Because pleural fluid reaccumulation was considered likely, she was discharged with close pulmonology follow-up for possible long-term PleurX catheter placement.<br /><br />The discussion emphasizes that pleural effusions in multiple myeloma may have several causes, including amyloidosis-related cardiomyopathy, pulmonary embolism, nephrotic syndrome, or chronic kidney disease. Proposed mechanisms for MPE include direct pleural invasion by tumor, extension from bone or lung disease, or spread from mediastinal extramedullary plasmacytoma. The main conclusion is that MPE signals aggressive disease and poor outcomes, so pleural effusions in myeloma should be evaluated promptly and thoroughly to guide either aggressive treatment or palliative care.

Asset Subtitle

Jahanzeb Saeed

Meta Tag

Author List Jahanzeb Saeed, Peter D. Le

Category Clinical Vignettes

Concept Multiple Myeloma

Concept Myelomatous Pleural Effusion

Concept Clonal Plasma Cell

Concept Pleural Effusion

Concept Thoracentesis

Distinguished Non-Finalist

Presenter Organization Virginia Tech Carilion (VTC)

Presenting Author Jahanzeb Saeed

Track Adult

Keywords

myelomatous pleural effusion

multiple myeloma

pleural effusion

lambda-restricted plasma cells

IgG lambda

thoracentesis

chest tube

exudative fluid

extramedullary plasmacytoma

poor prognosis

Multiple Myeloma

Myelomatous Pleural Effusion

Clonal Plasma Cell

Pleural Effusion

Thoracentesis