Multiple myeloma presenting clinically as lymphoma

Multiple myeloma typically presents with monoclonal proteinemia, marrow plasmacytosis, anemia, bony involvement, hypercalcemia and renal insufficiency. Less frequent presentations include hepatic and splenic enlargement (5% of cases), lymphadenopathy (4%) and biclonal gammopathy (1%). Chemotherapy may produce remissions in 50% of cases, but relapses are the rule and mean survival is approximately 2.5 years. To improve survival, marrow transplantation is being explored as a therapeutic modality in younger patients. In this report we describe a unique case of multiple myeloma presenting clinically as lymphoma. The patient presented with fever, widespread lymphadenopathy and pleuropulmonary involvement and responded promptly to multiagent doxorubicin-based chemotherapy. This was followed by high-dose chemotherapy and allogeneic bone marrow transplantation and the patient remains in remission more than 36 months post transplant. This case report suggests that myeloma simulating lymphoma may be a chemosensitive and potentially curable myeloma variant.