Büge ÖZ, Emre Fatma TURAN, Ünal Özge BAYRAKTAR, Canan TAHAOĞLU, Taha Bahadır ÜSKÜL, Alkın MELİKOĞLU, Hatice TÜRKER

Pleural effusion as the first sign of multiple myeloma

Multipl miyelom seyrek görülen retiküloendotelyal dışı dokuları tutan bir hastalıktır ve çok nadir miyelomatöz plevral efüzyona sebep olmaktadır. Elli altı yaşında erkek olgu son bir aydır olan nefes darlığı ve halsizlik şikayetleriyle kliniğimize başvurdu. PA akciğer grafisinde sol plevral efüzyon saptanan olgunun, plevral sıvısı eksüda karakterindeydi. Protein elektroforezinde hipergamaglobulinemi tespit edildi. Serum ve plevral sıvı immünfiksasyon elektroforezinde IgG ve kappa fraksiyonlarında artış saptandı. Yirmi dört saatlik idrarda Bence-Jones proteini yüksekti. Plevra biyopsisinde plazmosit infiltrasyonu gösterildi. Yapılan kemik iliği biyopsisinde difüz paternde IgG/Kappa klonalitesi taşıyan bazıları immatür morfolojide atipik plazma hücre infiltrasyonu görüldü. Bu bulgularla IgG/k tipi multipl miyelom tanısı konan hastaya vinkristin, doksorubisin ve prednizolondan oluşan kemoterapi başlandı. İlk kür sonrası plevral efüzyonu tamamen gerileyen hasta 18 aydır takip altındadır.

Multipl miyelomun ilk bulgusu olarak plevral efüzyon

Multiple myeloma (MM) is a rare disorder that affects all tissues, except reticuloendothelial tissues, and seldom causes a myelomatous pleural effusion. A 56-year-old male patient attended our clinic complaining of shortness of breath and fatigue for the past month. A posteroanterior chest radiograph revealed a left pleural effusion, which was subsequently assessed as being exudative in nature. Protein electrophoresis demonstrated hypergammaglobulinemia. Serum and pleural fluid immunofixation electrophoresis showed an increase in the IgG and kappa fractions. The Bence-Jones protein level in the 24-hours urine was high. Pleural biopsy showed plasmocyte infiltration. Bone marrow biopsy revealed atypical plasma cell infiltration, some with immature morphology, carrying IgG/Kappa clonality in a diffuse pattern. The patient was diagnosed with IgG/k type MM and underwent chemotherapy with vincristine, doxorubicin, and prednisolone. Complete regression of the pleural effusion was achieved after one round of chemotherapy, and the patient has been followed for 18 months.

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