Acute kidney failure and extramedullary lung infiltration as the initial presentation of multiple myeloma: A case report

Abstract

Introduction. Kidney failure in multiple myeloma is some-times initial symptomatology and a very serious complica-tion with an unfavorable effect on the course and prognosis of the disease. Multiple myeloma is a disease characterized by the proliferation of plasmocytes in the bone marrow, and in rare cases, it can be extramedullary in various organs and systems. Pulmonary plasmacytoma localization is a rare ex-tramedullary localization, especially when it represents one of the initial manifestations of multiple myeloma. Case re-port. We present a patient with progressive acute kidney failure who has started hemodialysis treatment. On chest radiography, a homogeneous shadow was observed along the left chest wall, and the multislice computed tomography (MSCT) pointed to the tumor formation in the pulmonary parenchyma in the projection of the left upper pulmonary lobe with signs of pleural infiltration, intercostal muscles, and V rib destruction. Laboratory examination indicated the presence of Bence-Jones proteinuria in the urine sample in addition to anemia syndrome and azotemia with hyperu-ricemia. After bronchoscopy and needle biopsy, diffuse in-filtration of mature plasma cells was demonstrated in the cy-tological and histopathological findings of the lungs. The histopathological finding of bone marrow biopsy indicated multiple myeloma of Lambda type with infiltration of plas-ma cells- A bout 70%. The hematologist determined a di-agnosis of multiple myeloma BJ lambda III BCS, with ex-tramedullary lung infiltration and acute kidney failure. Fur-ther treatment was continued according to the hematologi-cal protocol while performing intermittent hemodialysis. Conclusion. Sometimes, extremely rarely, and in complete-ly asymptomatic patients with massive pulmonary infiltra-tion observed initially, the differential diagnosis may also represent an extramedullary presentation of multiple mye-loma, which should be considered.