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Published on: March 30, 2018
[Aggressive myeloma with subcutaneous tumor and pericardial involvement]
R Takahashi1, E Ashihara, T Hirata
1Second Department of Medicine, Kyoto Prefectural University of Medicine.
Insights
This rare multiple myeloma case highlights pericardial effusion. High levels of interleukin-6 (IL-6) in the effusion correlated with myeloma cell proliferation, suggesting IL-6
Area of Science:
- Hematology
- Oncology
- Internal Medicine
Background:
- Multiple myeloma is a plasma cell malignancy.
- Extramedullary disease is common but pericardial involvement is rare.
Observation:
- A 67-year-old male presented with anemia, thrombocytopenia, and renal failure.
- Bone marrow biopsy revealed lymphoblastoid cell infiltration, diagnosing multiple myeloma (BJ-kappa, stage IIIB).
- The patient relapsed with subcutaneous tumors and pericardial effusion.
Findings:
- Myeloma cell invasion into the pericardial space was diagnosed.
- Interleukin-6 (IL-6) levels in pericardial effusion were significantly elevated (16382 pg/ml).
- In vitro studies showed myeloma cells from the effusion responded to IL-6.
Implications:
- This case suggests a strong correlation between high IL-6 levels and myeloma cell proliferation in pericardial effusions.
- IL-6 may play a critical role in the pathogenesis of myeloma pericardial effusions.
- Further research into IL-6 targeted therapies for such rare presentations is warranted.
Abstract:
A 67-year-old male was admitted to our hospital because of anemia, thrombocytopenia, and renal failure. On admission he showed splenomegaly and elevated serum LDH level. Bone marrow showed hypercellularity with massive infiltration of lymphoblastoid cells. He was diagnosed as having multiple myeloma (BJ-kappa, stage IIIB). He transiently responded to intensive chemotherapy (VAD, MP, IFN alpha) but relapsed with multiple subcutaneous tumors and pericardial effusion. This is a rare case that the myeloma cell invasion to pericardial space was diagnosed before his death. The level of interleukin 6 (IL-6) in pericardial effusion was 16382 pg/ml, and the myeloma cells obtained from the pericardial effusion responded to IL-6, which suggested that high level of IL-6 closely related to the proliferation of myeloma cells in this case.
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