Nicolas Palagano*, Nicolas Palagano, Costanza Marchiani, Giulia Bandini, Manfredi Gagliano, Elisa Cioni, Martina Zavagli, Iacopo Bertoletti, Giorgia Barbarisi, Silvia Bellando Randone and Alberto Moggi Pignone
Department of Internal Medicine, Careggi University Hospital, ItalyFulltext PDF
Approximately 6% of all patients with MM develop pleural effusion. Pleural effusions in MM are generally benign and due to conditions such as infections, hypoalbuminemia or congestive heart disease. Clinicopathological studies have revealed that the spleen, liver and lymph nodes are the most common sites of extramedullary disease with myelomatous pleural involvement resulting in less than 1% of all cases. We herein report about a 52 year old woman presenting to the Emergency Department of a tertiary care hospital with a lower back pain. We diagnosed a MM with a lambda light chain restriction presenting with multiple pleural nodules and pleural effusion as the first sign of the disease. The diagnose was made via semi rigid thoracoscopy and has been challenging since pleural involvement is a very rare manifestation of the disease, beeing even more rare as a first sign of it. Nevertheless physicians should be aware of the possibility of myelomatous pleural involvement both for prognostic and diagnostic reasons. We will report our case and review the general incidence, mechanisms of spread and treatment options of extramedullary disease. Finally we reviewed the literature on the association between MM and pleural involvement.
Palagano N, Palagano N, Marchiani C, Bandini G, Gagliano M, Cioni E, et al. Pleural Nodules and Effusion as a First Sign of Multiple Myeloma: Am Diagnostic Challenge. A Case Report and Literature Review on the Incidence, Mechanisms of Extramedullary Spread and Treatment Options of Extramedullary and Pleura l MM. J Hematol Mult Myeloma. 2019;4(1):1018.