Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA.
Mediterr J Hematol Infect Dis. 2012;4(1):e2012010. doi: 10.4084/MJHID.2012.010. Epub 2012 Jan 25.
Multiple Myeloma is a hematologic malignancy of plasma cell origin. Pleural effusion may develop in the setting of myeloma due to various reasons but is extremely uncommon as a presenting symptom. A 69-year-old Caucasian man presented with pleural effusions of undetermined etiology after extensive work up, and multiple failed pleurodesis. Lung biopsy revealed pulmonary amyloidosis and led to the diagnosis of multiple myeloma. Patient was started on chemotherapy but died within 6 weeks of his diagnosis due to multiorgan failure. Pulmonary amyloidosis should be suspected as a cause of intractable pleural effusions, even in patient who do not have evidence of lung involvement on imaging studies or typical features of multiple myeloma. Pleural effusions due to amyloidosis are often refractory to treatment, and a high index of suspicion is required for early diagnosis and treatment.
多发性骨髓瘤是一种浆细胞起源的血液系统恶性肿瘤。由于多种原因，骨髓瘤患者可能会出现胸腔积液，但作为首发症状极为罕见。一名 69 岁的白人男性在广泛检查后出现原因不明的胸腔积液，并多次胸腔粘连失败。肺活检显示为肺淀粉样变性，从而确诊为多发性骨髓瘤。患者开始接受化疗，但在诊断后 6 周内因多器官衰竭而死亡。即使在影像学检查或多发性骨髓瘤的典型特征无肺部受累的患者中，也应怀疑肺部淀粉样变性是导致难治性胸腔积液的原因。由于淀粉样变性导致的胸腔积液通常对治疗有抗性，因此需要高度怀疑以实现早期诊断和治疗。
