Abstract
A case of diffuse normolipemic plane xanthoma associated with multiple myeloma and pulmonary fibrosis was reported. The patient was a 61-year-old male complaining of general fatigue and yellow-colored skin.
The erythrocyte sedimentation rate was 158mm/hr. The serum protein was 8.4g/dl and a monoclonal pattern was observed in γ-globulin area. The serum lipid level was normal. The bone marrow examination showed typical myeloma cells. Diagnosis of IgG kappa type multiple myeloma was made by immunoelectrophoretic examination of the serum and urine. The skin biopsy specimen showed typical foam cells. His chest roentgenogram revealed diffuse micronodular shadows in the bilateral lower lung fields.
Pulmonary function studies showed normal total lung capacity, residual volume, vital capacity and FEV1.0. Airway resistance and static compliance were normal, too. But diffusing capacity was markedly decreased. Lung specimens obtained by transbronchial lung biopsy revealed interstitial fibrosis. There were no amyloid deposits. Serum HDL-Paraprotein and VLDL-Paraprotein immunocomplexes were demonstrated by passive haemagglutination test.
In our case, this interaction may have resulted in autoimmune dyslipidemia, diffuse plane xanthoma and pulmonary fibrosis. The pulmonary involvement of diffuse plane xanthoma associated with myeloma is rare. In the literature, our case is the first report in Japan.
