A Case of IgD-k Multiple Myeloma Complicated by Abnormal Plasma Cells in the Pleural Effusion

Abstract

A 64 year-old man was admitted to Tokai University Hospital because of chest pain and lumbago. Chest rentogenogram showed a mass on the right 3rd rib and pleural effusion. Cytologically, numerous atypical plasma cells were found in pleural effusion. Therefore myeloma was diagnosed. Immunoelectrophoresis revealed monoclonal IgD (k) in serum and pleural effusion. Quantitative immunogloblin determination indicated marked increases in IgD (1850mg/d1) in serum, and in pleural effusion (350mg/dl). Biopsy of the bone marrow showed numerous atypical plasma cells. Skeletal radiographic survey revealed punched-out lesions in the skull and pelvic bone. He Was treated with melphalan and prednisolone, but died 6 months after the onset. We estimated that accumulation of pleural effusion was caused by direct invasion of the 3rd rib tumor to the pleura.
The incidence of myeloma associated with pleural effusion is so rare that we could find only 15 cases reported in Japan.