Pleural Effusion in a Patient with Multiple Myeloma

[摘要] A 62-year-old woman presenting with dyspnea on exertion was admitted to our hospital. Her medical history included type 2 diabetes and κ light chain multiple myeloma (MM) diagnosed 3 years ago.The results of a basic biochemical examination performed 2 weeks earlier were normal. Serum protein electrophoresis revealed hypoproteinemia (65 g/L; reference interval, 68–73 g/L), associated with decreased γ globulins (4 g/L; reference interval, 9–15 g/L) but without a detectable paraprotein band. An assay for serum free light chain showed decreased κ light chains (0.5 mg/L; reference interval, 3.3–19.4 mg/L) and λ light chains (<0.3 mg/L; reference interval, 5.7–26.3 mg/L); the κ/λ ratio could not be accurately determined because of the low concentration of λ light chains. An examination of a bone marrow aspirate taken 3 months earlier showed dystrophic plasma cells accounting for 50% of the nucleated cells.On admission, laboratory tests revealed normal values for hemoglobin (142 g/L; reference interval, 130–180 g/L), white blood cells (6.7 × 109/L; reference interval, 4–10 × 109/L), platelets (211 × 109/L; reference interval, 150–400 × 109/L), and creatinine [38 μmol/L (0.4 mg/dL); reference interval, 45–90 μmol/L (0.5–1.0 mg/dL)], but the tests also revealed mild hypocalcemia [2.14 mmol/L (8.6 mg/dL); reference interval, 2.20–2.60 mmol/L (8.8–10.4 mg/dL)].A chest radiograph and spiral thoracic computed tomography showed a large right-sided pleural effusion.A sample of the pleural fluid had a total protein concentration of 38 g/L and a white blood cell count of 20.5 × 109/L, with 100% lymphoid cells. The results of bacterial and mycobacterial cultures were negative. Protein electrophoresis evaluations of serum, urine, and the …

[学科分类] 过敏症与临床免疫学