High-output cardiac failure revealing primary plasma cell leukemia

Area of Science:

• Hematology
• Cardiology
• Oncology

Background:

• High-output cardiac failure (HOCF) is a known complication of multiple myeloma (MM), typically associated with arteriovenous shunting in bone lesions.
• Primary plasma cell leukemia (pPCL) is a rare and aggressive variant of multiple myeloma.

Purpose of the Study:

• To describe a case of HOCF in a patient with pPCL without bone disease.
• To review potential mechanisms of HOCF in this context.
• To highlight the implications for patient management.

Main Methods:

• Case report presentation.
• Review of existing literature on MM and pPCL-related cardiac complications.
• Discussion of potential pathophysiological mechanisms.

Main Results:

• A patient with pPCL developed HOCF despite the absence of bone infiltration.
• Arteriovenous shunting was implicated as the cause of HOCF.
• Conventional therapies for cardiac failure were ineffective.

Conclusions:

• HOCF can occur in pPCL even without bone disease, likely due to arteriovenous shunting.
• Standard cardiac failure management strategies are not effective for this specific complication.
• Initiation of pPCL-specific therapy is crucial and should not be postponed.