Abstract
A 62 year-old man with prostatic hypertrophy was admitted to our hospital. Preoperative examination revealed IgA-κ M-proteinemia; moderate osteoporosis and bone marrow infiltration by immature plasma cells, leading to a diagnosis of multiple myeloma. He also had hyperviscosity syndrome; headache, retinal bleeding and retinal vein engorgement; the relative viscosity of the serum was 5.7. Plamapheresis was performed until the relative viscosity decreased to 2.91. He underwent suprapubic prostatectomy on the 36th day after admission. Massive hemorrhage (2,800ml) occurred intraoperatively. Between 1970∼1980, 14 cases of myeloma with hyperviscosity syndrome were reported in the Japanese literature. These cases suggested a relationship between hyperviscosity syndrome and the molecular configuration (polymerization or aggregation) rather than the amount of the myeloma protein. Analytical ultracentrifugation of our patient's serum demonstrated the presence of polymerized IgA. Postoperatively he had a mild degree of anemia and thrombocytopenia; on the 10th day after surgery, immature plasma cells appeared in the peripheral blood and a few days later, right pleural effusion was observed. The effusion contained many myeloma cells. The patient died on the 84th hospital day of respiratory failure. At autopsy, myeloma cells were found in the bone marrow, liver, spleen, pancreas, kidney, right pleura and pericardium of the right atrium.
