Abstract
Although rib involvement may occur in patients with multiple myeloma, the development of pathological flail chest is rare. We experienced a patient with multiple myeloma who presented with flail chest and respiratory failure. A 63-year-old man with multiple myeloma experienced multiple rib fractures and complained of chest pain and dyspnea. The patient underwent chemotherapy, but treatment was discontinued because he developed drug-induced hypersensitivity syndrome. His dyspnea and chest pain progressed, and he was admitted to the ICU. Even after endotracheal intubation, flail chest of the lower thoracic segments were evident bilaterally on inspiration. A PEEP was applied and increased up to 15 cmH2O to stabilize his flail chest. The patient underwent a tracheostomy, as the duration of ventilatory support was expected to be lengthy. The PEEP was gradually decreased to 6 cmH2O on day 27 after endotracheal intubation, while avoiding the occurrence of flail chest. After treatment with a high dose of dexamethasone starting on day 73, his chest pain was gradually alleviated, and his flail chest disappeared, as evidenced by a CT scan. The patient was weaned from long-term ventilatory support on day 131.
