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Published on: July 3, 2013
Atrial plasmacytoma and hypercalcemia
Lori A Brame1, Rohit Dwivedi, Todd W Rice
1Indiana University School of Medicine, Division of Endocrinology, Emerson Hall 421, 545 Barnhill Drive, Indianapolis, IN 46202, USA.
Insights
This case report details a patient with hypercalcemia caused by multiple myeloma and an unusual atrial plasmacytoma. It highlights the importance of considering plasmacytoma in multiple myeloma diagnoses when localized symptoms appear.
Area of Science:
- Oncology
- Hematology
- Cardiology
Background:
- Multiple myeloma is a plasma cell malignancy.
- Hypercalcemia is a common complication of multiple myeloma.
- Plasmacytomas are localized plasma cell tumors.
Observation:
- A 48-year-old woman presented with hypercalcemia, anemia, thrombocytopenia, and renal insufficiency.
- Diagnosed with multiple myeloma, she developed a subdural hematoma and atrial plasmacytoma.
- Autopsy revealed disseminated myeloma and the atrial plasmacytoma.
Findings:
- The patient's hypercalcemia was attributed to multiple myeloma.
- An atrial plasmacytoma was identified as an associated finding.
- The case illustrates rare presentations of multiple myeloma.
Implications:
- This case underscores the need to consider plasmacytomas in the differential diagnosis of multiple myeloma.
- Recognizing plasmacytomas is crucial for accurate diagnosis and management.
- Further research into the extraskeletal manifestations of multiple myeloma is warranted.
Objective:
To describe a patient with hypercalcemia due to multiple myeloma and an associated atrial plasmacytoma.
Methods:
A case report is presented with clinical and laboratory findings. We review the differential diagnosis of hypercalcemia and discuss multiple myeloma and plasmacytomas.
Results:
A 48-year-old woman presented to the emergency department with lethargy after sustaining trauma to the head. She was found to have a subdural hematoma and a parietal intraparenchymal hemorrhage. She had a serum calcium level of 17.2 mg/dL (normal, 8.4 to 10.6), anemia, thrombocytopenia, and renal insufficiency. Serum protein electrophoresis revealed a monoclonal gammopathy, and a bone marrow biopsy specimen was consistent with multiple myeloma. The patient required surgical evacuation of her subdural hematoma. Postoperatively, multiple complications developed, including a supraventricular tachycardia. She did not regain consciousness, and ventilatory support was withdrawn. On autopsy, she was found to have disseminated myeloma and an atrial plasmacytoma.
Conclusion:
This case report emphasizes the need to consider a plasmacytoma as a manifestation of multiple myeloma when localizing symptoms are present.
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