title: Pleural effusion as the first sign of multiple myeloma.
abstract: Multiple myeloma (MM) is a rare disorder that affects all tissues, except reticuloendothelial tissues, and seldom causes a myelomatous pleural effusion. A 56-year-old male patient attended our clinic complaining of shortness of breath and fatigue for the past month. A posteroanterior chest radiograph revealed a left pleural effusion, which was subsequently assessed as being exudative in nature. Protein electrophoresis demonstrated hypergammaglobulinemia. Serum and pleural fluid immunofixation electrophoresis showed an increase in the IgG and kappa fractions. The Bence-Jones protein level in the 24-hours urine was high. Pleural biopsy showed plasmocyte infiltration. Bone marrow biopsy revealed atypical plasma cell infiltration, some with immature morphology, carrying IgG/Kappa clonality in a diffuse pattern. The patient was diagnosed with IgG/k type MM and underwent chemotherapy with vincristine, doxorubicin, and prednisolone. Complete regression of the pleural effusion was achieved after one round of chemotherapy, and the patient has been followed for 18 months.
authors.affiliation: Department of Chest Diseases, Süreyyapaşa Chest Diseases and Chest Surgery Teaching and Research Hospital, and Department of Pathology, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey. tbuskul@yahoo.com
authors.forename: Bahadir Taha
authors.initials: BT
authors.lastname: Uskül
authors.forename: Hatice
authors.initials: H
authors.lastname: Türker
authors.forename: Fatma
authors.initials: F
authors.lastname: Emre Turan
authors.forename: Ozge
authors.initials: O
authors.lastname: Unal Bayraktar
authors.forename: Alkin
authors.initials: A
authors.lastname: Melikoğlu
authors.forename: Canan
authors.initials: C
authors.lastname: Tahaoğlu
authors.forename: Büge
authors.initials: B
authors.lastname: Oz
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001536:Bence Jones Protein / Q000378:metabolism / Q000652:urine; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D010996:Pleural Effusion / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D001536:Bence Jones Protein