title: Unsuspected multiples myeloma presenting as bilateral pleural effusion - a cytological diagnosis.
abstract: BACKGROUND
  Multiple Myeloma presenting as a pleural effusion is extremely rare. It is usually a late complication and is associated with a poor prognosis.
  
  
  METHODS
  A 40-year-old male presented with dyspnea and fever of six months duration. Clinical diagnosis of pulmonary tuberculosis was considered. X-ray chest showed bilateral pleural effusion. Pleural cytology revealed numerous plasma cells, some of which were binucleated and atypical. Cytological differential diagnosis included: Myelomatous effusion and Non-Hodgkin's Lymphoma deposit (Immunoblastic type). Bone marrow biopsy, serum protein electrophoresis and bone scan confirmed the diagnosis of multiple myeloma (Plasmablastic type).
  
  
  CONCLUSIONS
  Myelomatous pleural effusion as an initial presentation although extremely rare, should always be considered in presence of atypical plasma cells irrespective of age.
authors.affiliation: Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi 110002, India. kajaldhingra@yahoo.com
authors.forename: Kajal Kiran
authors.initials: KK
authors.lastname: Dhingra
authors.forename: Niti
authors.initials: N
authors.lastname: Singhal
authors.forename: Sonu
authors.initials: S
authors.lastname: Nigam
authors.forename: Shayama
authors.initials: S
authors.lastname: Jain