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Recurrent pleural effusion in myeloma

Wing Hang Woo1, Azlin Ithnin2, Mohd Asyiq Al-Fard Mohd Raffali1

  • 1Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.

Oxford Medical Case Reports
|August 22, 2022
PubMed

Insights

This study discusses myelomatous pleural effusion (MPE), a rare complication of myeloma. Early recognition and multidisciplinary management are crucial for treating MPE and improving patient quality of life.

Area of Science:

  • Hematology
  • Oncology

Background:

  • Plasma cell (PC) disorders encompass myeloma and amyloidosis.
  • Pleural effusion in myeloma is uncommon, potentially caused by direct infiltration or cardiac amyloidosis.
  • Diagnosis involves analyzing pleural fluid and tissue samples.

Observation:

  • A 74-year-old man with immunoglobulin A myeloma presented with recurrent myelomatous pleural effusion (MPE).
  • The MPE was refractory to standard treatments like drainage and pleurodesis, despite partial remission of serum paraprotein.
  • Secondary cardiac amyloidosis was suspected as a contributing factor.

Findings:

  • Myelomatous pleural effusion (MPE) diagnosis relies on cytomorphology, flow cytometry, protein electrophoresis, or biopsy.
  • Treatment focuses on eradicating the underlying myeloma and managing respiratory symptoms.
  • Refractory MPE poses significant challenges, especially in older patients.

Implications:

  • Early identification of extramedullary myeloma infiltration and secondary amyloidosis is critical.
  • Multidisciplinary care is essential for symptom management and enhancing quality of life in MPE patients.
  • Chemotherapy intensification in elderly patients requires careful consideration.

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