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Coincidence of plasma cell leukemia and COVID-19: a diagnostic pitfall
Margot Egger1,2, Anne Black3,4, Christoph Robier5,6
1Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz and Ordensklinikum Linz, Seilerstaette 4, 4020, Linz, Austria. margot.egger-salmhofer@okh-lab.at.
Abstract:
We report the case of a 66-year-old man with a known history of IgD multiple myeloma (MM) which was admitted to hospital because of acute renal failure. Routine PCR testing on admission yielded a positive result for SARS-CoV-2 infection. Examination of the peripheral blood (PB) smear revealed 17% lymphoplasmacytoid cells and a few small plasma cells mimicking morphological changes frequently seen in viral diseases. However, flow cytometric examination showed 20% clonal lambda-restricted plasma cells being consistent with a diagnosis of secondary plasma cell leukemia. Circulating plasma cells as well as similar appearing lymphocyte subtypes such as plasmacytoid lymphocytes are frequently observed in infectious disorders such as COVID-19, so that the lymphocyte morphology in our patient's case could have been easily misinterpreted as typical COVID-19-induced changes. Our observation highlights the importance of incorporating clinical, morphological, and flow-cytometric data in distinguishing between reactive and neoplastic lymphocyte changes because misinterpretation may affect disease classification and, beyond that, clinical decision-making, which may have serious consequences for patients.
Insights
This case study highlights how COVID-19 infection can mimic multiple myeloma (MM) cell changes. Accurate diagnosis requires integrating clinical, morphological, and flow-cytometric data to differentiate reactive from neoplastic cells.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Multiple myeloma (MM) is a hematologic malignancy characterized by clonal plasma cell proliferation.
- IgD multiple myeloma is a rare subtype of MM.
- Acute renal failure is a common complication in multiple myeloma patients.
Observation:
- A 66-year-old man with IgD multiple myeloma presented with acute renal failure.
- SARS-CoV-2 infection was confirmed via PCR testing.
- Peripheral blood smear showed lymphoplasmacytoid cells, mimicking viral infection changes.
Findings:
- Flow cytometry revealed 20% clonal lambda-restricted plasma cells, indicating secondary plasma cell leukemia.
- Morphological similarities between reactive lymphocytes in COVID-19 and neoplastic plasma cells can lead to misdiagnosis.
- Distinguishing reactive versus neoplastic lymphocyte changes is critical.
Implications:
- Misinterpretation of lymphocyte morphology can affect disease classification and clinical decision-making.
- Integrated diagnostic approaches combining clinical, morphological, and flow-cytometric data are essential.
- This case underscores the importance of careful evaluation in immunocompromised patients with concurrent infections.
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