SHM Converge Scientific Abstract ePoster Gallery-Oh Myeloma! A Rare Pleural Manifestation of Multiple Myeloma With Prognostic Implications

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This case report describes a rare but important complication of multiple myeloma: myelomatous pleural effusion (MPE), which occurs in fewer than 1% of cases and usually signals aggressive disease and poor prognosis. MPE results from malignant plasma cell involvement of the pleura and can be diagnosed through pleural fluid cytology, flow cytometry, or pleural biopsy.<br /><br />The patient was a 71-year-old woman with a history of ovarian cancer who presented with three weeks of dry cough, exertional dyspnea, nausea, vomiting, fatigue, anorexia, and 20-pound weight loss. She was found to have severe anemia, acute kidney injury, and metabolic abnormalities. Chest CT showed a large pleural effusion along with masses near the right 6th rib and posterior mediastinum. Thoracentesis revealed atypical plasma cells. Further testing demonstrated a markedly elevated kappa/lambda ratio and an IgG monoclonal spike. Biopsy confirmed CD138-positive, kappa-restricted plasma cells, and bone marrow biopsy showed 80–90% plasma cell infiltration, confirming IgG kappa multiple myeloma with plasmacytoma and pleural involvement.<br /><br />She was initially treated with CyBorD because lenalidomide was avoided due to renal failure. After renal improvement, therapy was escalated to D-VRd, including daratumumab, to deepen response. The report emphasizes that although the patient had favorable cytogenetics and beta-2-microglobulin, MPE still indicates high-risk, extramedullary disease with a poor overall survival.<br /><br />The authors stress the need for hospitalists and clinicians to recognize unexplained pleural effusions, dyspnea, or cough as possible presentations of multiple myeloma. Early thoracentesis, cytologic evaluation, and serum studies are essential for timely diagnosis and treatment.

Asset Subtitle

Candice Hanna

Meta Tag

Author List Aaron Sidhu, Candice Hanna, Harneet Grewal, Joey Bettencourt Jr., Ziyang Liu

Category Clinical Vignettes

Concept Myelomatous Pleural Effusion

Concept Multiple Myeloma

Concept Renal Dysfunction

Concept Extramedullary Manifestation

Concept Pleural Effusion

Distinguished Non-Finalist

Presenter Organization Abrazo Health Internal Medicine Residency

Presenting Author Candice Hanna

Track Adult

Keywords

multiple myeloma

myelomatous pleural effusion

pleural effusion

plasma cells

IgG kappa

extramedullary disease

thoracentesis

plasmacytoma

daratumumab

renal failure

Myelomatous Pleural Effusion

Multiple Myeloma

Renal Dysfunction

Extramedullary Manifestation

Pleural Effusion