Myeloma multiplex with pulmonary dissemination

Abstract

Introduction. Multiple myeloma is a hemathological malignancy characterized by the clonal proliferation of plasma cells in the bone the marrow. Extramedullary dissemination of multiple myeloma is uncommon. In several cases only, the multiple myeloma malignant plasma cells had diseminated to the lung parenchyma. Case report. We presented a case of multiple myeloma with lung plasmacytoma, in a 79-year-old patient, hospitalized for febrility and infiltrative mass in the right lung. Two months before the patient was admitted, because of developing terminal renal failure, hemodialysis treatment had started three times a week. Since then, the patient was oliguric, but because of febrility and hemoptysis that appeared, at first he was treated with dual antibiotic therapy which resulted in temporary improvement of his general condition, but pleural effusion remained. After thoracocentesis, followed by myelogram, the multiple myeloma diagnosis was established. Conclusion. In patients of middle and older age, with general weakness, exhaustion, loss of weight, renal failure which progresses to the end stage rapidly, if symptoms of respiratory tract occur, consider this uncommon disease - extramedullary dissemination of multiple myeloma.Uvod. Multipli mijelom je hematolosko maligno oboljenje koje se odlikuje klonalnom proliferacijom plazma celija u kostanu srz. Ekstramedularna diseminacija multiplog mijeloma izuzetno je retka. U samo nekoliko slucajeva opisana je diseminacija multiplog mijeloma u pluca. Prikaz bolesnika. Prikazali smo bolesnika sa multiplim mijelomom plucne lokalizacije, starog 79 godina, koji je hospitalizovan zbog febrilnosti i infiltrativne promene u desnom plucu. Dva meseca pre prijema, zbog razvoja terminalne bubrezne slabosti, zapoceto je lecenje hemodijalizom, tri puta nedeljno. Od tog perioda bolesnik je bio oligurican, a zbog pojave febrilnosti i hemoptizija lecen je najpre dvojnom antibiotskom terapijom, na ciju primenu je doslo do prolaznog poboljsanja opsteg stanja, ali bez povlacenja pleuranog izliva. Nakon ucinjene torakocenteze, a potom i mijelograma, postavljena je dijagnoza multiplog mijeloma. Zakljucak. Kod bolesnika srednjeg i starijeg zivotnog doba uz opstu slabost, malaksalost, gubitak telesne mase, bubreznu insuficijenciju koja brzo progredira do terminalne, ukoliko se pojave simptomi u respiratornom traktu, diferencijalno dijagnosticki treba razmisljati i o ekstramedularnoj, plucnoj diseminaciji multiplog mijeloma.