title: Lung postmortem autopsy revealing extramedullary involvement in multiple myeloma causing acute respiratory distress syndrome.
abstract: Pulmonary involvement with multiple myeloma is rare. We report the case of a 61-year-old man with past medical history of chronic respiratory failure with emphysema, and a known multiple myeloma (Durie and Salmon stage III B and t(4;14) translocation). Six months after diagnosis and first line of treatment, he presented acute dyspnea with interstitial lung disease. Computed tomography showed severe bullous emphysema and diffuse, patchy, multifocal infiltrations bilaterally with nodular character, small bilateral pleural effusions, mediastinal lymphadenopathy, and a known lytic lesion of the 12th vertebra. He was treated with piperacillin-tazobactam, amikacin, oseltamivir, and methylprednisolone. Finally, outcome was unfavourable. Postmortem analysis revealed diffuse and nodular infracentimetric infiltration of the lung parenchyma by neoplastic plasma cells. Physicians should be aware that acute respiratory distress syndrome not responding to treatment of common causes could be a manifestation of the disease, even with negative BAL or biopsy and could be promptly treated with salvage therapy.
authors.affiliation: Réanimation Adultes et Unité de Soins Continus, CHU Estaing, 1 Place Lucie-et-Raymond-Aubrac, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France ; Service d'Hématologie, CHU Estaing, CHU Clermont-Ferrand, 1 Place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Ravinet
authors.affiliation: Réanimation Adultes et Unité de Soins Continus, CHU Estaing, 1 Place Lucie-et-Raymond-Aubrac, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France ; R2D2, EA 7281, INSERM, Faculté de Médecine, Université d'Auvergne, Place Henri Dunant, 63001 Clermont-Ferrand, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Perbet
authors.affiliation: Service d'Hématologie, CHU Estaing, CHU Clermont-Ferrand, 1 Place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France ; INSERM CIC-501, EA 7283, CHU Estaing, Université d'Auvergne, 1 Place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Guièze
authors.affiliation: Service d'Hématologie, CHU Estaing, CHU Clermont-Ferrand, 1 Place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France ; Service d'Anatomo-Pathologie, CHU Estaing, CHU Clermont-Ferrand, 1 Place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: Richard
authors.identifier: 0000-0002-5767-1628
authors.initials: R
authors.lastname: Lemal
authors.affiliation: Réanimation Adultes et Unité de Soins Continus, CHU Estaing, 1 Place Lucie-et-Raymond-Aubrac, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Guérin
authors.affiliation: Réanimation Adultes et Unité de Soins Continus, CHU Estaing, 1 Place Lucie-et-Raymond-Aubrac, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gayraud
authors.affiliation: Réanimation Adultes et Unité de Soins Continus, CHU Estaing, 1 Place Lucie-et-Raymond-Aubrac, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France.
authors.forename: Jugurtha
authors.initials: J
authors.lastname: Aliane
authors.affiliation: Réanimation Adultes et Unité de Soins Continus, CHU Estaing, 1 Place Lucie-et-Raymond-Aubrac, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Tremblay
authors.affiliation: Réanimation Adultes et Unité de Soins Continus, CHU Estaing, 1 Place Lucie-et-Raymond-Aubrac, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Pascal
authors.affiliation: Service d'Anatomo-Pathologie, CHU Estaing, CHU Clermont-Ferrand, 1 Place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: Albane
authors.initials: A
authors.lastname: Ledoux
authors.affiliation: Service d'Hématologie, CHU Estaing, CHU Clermont-Ferrand, 1 Place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Chaleteix
authors.affiliation: Service d'Anatomo-Pathologie, CHU Estaing, CHU Clermont-Ferrand, 1 Place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Dechelotte
authors.affiliation: Service d'Hématologie, CHU Estaing, CHU Clermont-Ferrand, 1 Place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France ; INSERM CIC-501, EA 7283, CHU Estaing, Université d'Auvergne, 1 Place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: Jacques-Olivier
authors.initials: JO
authors.lastname: Bay
authors.affiliation: Réanimation Adultes et Unité de Soins Continus, CHU Estaing, 1 Place Lucie-et-Raymond-Aubrac, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France.
authors.forename: Jean-Etienne
authors.initials: JE
authors.lastname: Bazin
authors.affiliation: Réanimation Adultes et Unité de Soins Continus, CHU Estaing, 1 Place Lucie-et-Raymond-Aubrac, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France ; R2D2, EA 7281, INSERM, Faculté de Médecine, Université d'Auvergne, Place Henri Dunant, 63001 Clermont-Ferrand, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin