title: Myelomatous Pleural Effusion Presenting with Extreme Hyperferritinemia and Severe Inflammatory Response.
abstract: Myelomatous involvement of pleural effusions developing in patients with multiple myeloma is extremely rare and only a few cases have been reported so far. It is thought to represent an aggressive clinical progression of disease and is usually associated with severe complications, poor prognosis and high mortality. Ferritin is a marker of inflammatory pathways that plays a significant role in plasma cell malignancies and has been studied as a prognostic factor for multiple myeloma. In severe inflammatory states such as septic shock or hemophagocytic lymphohistiocytosis, extreme levels of ferritin are thought to precipitate a cytokine storm associated with poor clinical outcomes. We present a case of myelomatous pleural effusion associated with extreme levels of ferritin and explore the possibility of a connection between this rare entity and other severe inflammatory states, which could account for its ominous outcomes and poor prognosis.
authors.affiliation: Icahn School of Medicine at Mount Sinai, St. Luke's-Roosevelt Hospital Center Residency program, New York, N.Y., USA.
authors.forename: Diego A Adrianzen
authors.initials: DA
authors.lastname: Herrera
authors.affiliation: Department of Medicine, Mount Sinai St. Luke's-Roosevelt Hospital, New York, N.Y., USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Scott
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Mount Sinai St. Luke's-Roosevelt Hospital, New York, N.Y., USA.
authors.forename: Mala
authors.initials: M
authors.lastname: Varma
keywords: Hyperferritinemia; Multiple myeloma; Pleural effusion