title: Myelomatous pleural effusion as an initial sign of multiple myeloma-a case report and review of literature.
abstract: OBJECTIVE
  Discuss and improve the understanding of the clinical characters and diagnostic methods of myelomatous pleurisy, particularly of the patients with pleural effusion as an initial manifestation.
  
  
  BACKGROUND
  A 53-year-old male, who had been misdiagnosed as tuberculous pleurisy in a local hospital, was diagnosed as multiple myeloma (MM) with pleural infiltration. We reviewed the literature on clinical manifestations, serum and pleural effusion characters, treatment and diagnostic options of this exceptionally rare presentation of MM.
  
  
  METHODS
  We conducted a search of the published medical literature since 2000 in MEDLINE and PubMed using search criteria [("pleural effusion" and "MM") or "myelomatous pleural effusions"]. The search led to 64 case reports, and 16 cases with pleural effusion as an initial manifestation were included in this review. We have also searched for recent advances in diagnosis.
  
  
  CONCLUSIONS
  Myelomatous pleurisy is a rare complication of MM. Its clinical and laboratory findings are non-specific. Definitive diagnosis relies on the histopathology of pleural biopsy or pleural effusion. Thoracoscopic pleural biopsy is reliable, safe and effective. Chemotherapy is the mainstay of treatment for myelomatous pleural effusion. However, the response rate is low with an overall median survival time of 4 months.
authors.affiliation: Department of Respiratory & Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Zhang
authors.affiliation: Department of Respiratory & Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Yuan-Yuan
authors.initials: YY
authors.lastname: Li
authors.affiliation: Department of Respiratory & Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Cheng-Ping
authors.initials: CP
authors.lastname: Hu
authors.affiliation: Department of Respiratory & Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Hua-Ping
authors.initials: HP
authors.lastname: Yang
keywords: Multiple myeloma (MM); adenosine deaminase (ADA); extramedullary infiltration; myelomatous pleural effusion; thoracoscope technology
references.citation: Isr Med Assoc J. 2009 Feb;11(2):118-9
references.pmid: 19432043
references.citation: Chest. 1994 Jul;106(1):33-7
references.pmid: 8020316
references.citation: Acta Cytol. 2000 Jan-Feb;44(1):103-4
references.pmid: 10667171
references.citation: Eur J Intern Med. 2007 Jul;18(4):348-9
references.pmid: 17574119
references.citation: Chest. 1973 Aug;64(2):246-8
references.pmid: 4725083
references.citation: Acta Cytol. 2010 Sep-Oct;54(5 Suppl):780-2
references.pmid: 21053539
references.citation: Korean J Lab Med. 2011 Oct;31(4):225-30
references.pmid: 22016674
references.citation: Clin Chest Med. 2013 Mar;34(1):21-6
references.pmid: 23411053
references.citation: Chest. 2010 Jun;137(6):1362-8
references.pmid: 20154079
references.citation: Thorax. 1995 Jun;50(6):600-3
references.pmid: 7638798
references.citation: Med J Malaysia. 2008 Oct;63(4):298-301
references.pmid: 19385488
references.citation: Arch Intern Med. 1978 May;138(5):727-30
references.pmid: 646535
references.citation: Clin Biochem. 2005 Oct;38(10):887-91
references.pmid: 16054616
references.citation: Leuk Lymphoma. 2005 Aug;46(8):1137-42
references.pmid: 16085553
references.citation: Chest. 1994 Feb;105(2):622-4
references.pmid: 8306782
references.citation: J Korean Med Sci. 2000 Apr;15(2):243-6
references.pmid: 10803706
references.citation: Intern Med. 2008;47(21):1917-20
references.pmid: 18981637
references.citation: Arch Intern Med. 1998 Oct 12;158(18):2017-21
references.pmid: 9778201
references.citation: J Clin Oncol. 2005 May 20;23(15):3412-20
references.pmid: 15809451
references.citation: Eur J Med Res. 2013 Mar 20;18:7
references.pmid: 23514274
references.citation: Pathologica. 2010 Jun;102(3):83-7
references.pmid: 21171509
references.citation: J Microbiol Immunol Infect. 2011 Apr;44(2):88-94
references.pmid: 21439509
references.citation: Cytojournal. 2007 Sep 07;4:17
references.pmid: 17825100
references.citation: Rinsho Byori. 1990 Jun;38(6):703-10
references.pmid: 2381093
references.citation: Thorax. 1995 Jun;50(6):672-4
references.pmid: 7638812
references.citation: Br J Cancer. 1976 Mar;33(3):312-9
references.pmid: 1063590
references.citation: Arch Intern Med. 1973 Dec;132(6):854-60
references.pmid: 4757257
references.citation: Leuk Lymphoma. 2006 Mar;47(3):565-8
references.pmid: 16396783
references.citation: Respirology. 2010 Apr;15(3):451-8
references.pmid: 20345583
references.citation: Leuk Res. 2005 Jun;29(6):715-8
references.pmid: 15863214
references.citation: Acta Haematol. 2008;120(2):108-11
references.pmid: 18957845
references.citation: Tuberk Toraks. 2008;56(4):439-42
references.pmid: 19123081
references.citation: Mediterr J Hematol Infect Dis. 2012;4(1):e2012063
references.pmid: 23170192
references.citation: Indian J Hematol Blood Transfus. 2010 Jun;26(2):62-4
references.pmid: 21629638
references.citation: Clin Chem. 1996 Feb;42(2):218-21
references.pmid: 8595713
references.citation: Clin Chem. 2012 Apr;58(4):672-4
references.pmid: 22461512
references.citation: Intern Med. 1992 May;31(5):617-21
references.pmid: 1504423
references.citation: Asia Pac J Clin Oncol. 2010 Dec;6(4):256-9
references.pmid: 21114774
references.citation: Respir Med. 2008 May;102(5):744-54
references.pmid: 18222681