A Case of Multiple Myeloma Associated with Abnormal Plasma Cells and M-protein in Pleural Effusion

• Published in: Nihon Rōnen Igakkai zasshi Vol. 33; no. 3; pp. 196 - 199
• Main Authors: Araki, Tsutomu, Tofuku, Yohei
• Format: Journal Article
• Language: Japanese
• Published: Japan The Japan Geriatrics Society 1996
• Subjects: Aged; Connectin; Female; Humans; Multiple myeloma; Multiple Myeloma - complications; Muscle Proteins; Myeloma Proteins - metabolism; Plasma Cells - pathology; Pleural effusion; Pleural Effusion - chemistry; Pleural Effusion - pathology
• ISSN: 0300-9173
• DOI: 10.3143/geriatrics.33.196

A 77-year-old woman with hypertension was admitted to our hospital because of exertional dyspnea end peripheral edema. Chest X-ray showed cardiomegaly, pulmonary congestion and right pleural effusion. Hypertensive heart failure was diagnosed and treated, and right pleural effusion disappeared in 2 weeks. Abnormalities on laboratory data, i.e. anemia and increased ESR et al. continued after the improvement of heart failure. Serum IgG was elevated (2570mg/dl), while IgA and IgM were decreased. Immunoelectrophoresis indicated the presence of monoclonal IgG-λ in the serum. Bone marrow puncture revealed an increase in atypical plasma cells (38.4%). Multiple myeloma was diagnosed from these findings and treated with melphalan and prednisolone. But increases in atypical plasma cells (43.2%) and serum IgG (2573mg/dl) continued. During treatment, right pleural effusion increased again. Thoracocentesis showed bloody effusion with numerous atypical plasma cells, and the presence of monoclonal IgG-λ was indicated by immunoelectrophoresis. The patient died of renal and heart failure 2 months after the onset of malignant pleural effusion. Cytological examination and immunoelectrophoresis are necessary for pleural effusion in multiple myeloma.