Multiple myeloma with myelomatous pleural effusion and mediastinal plasmacytoma – A rare association

Abstract

Multiple myeloma, a relatively uncommon malignancy accounting for approximately 1%–2% of all cancers, is characterized by neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. While it mainly affects bone marrow, thoracic manifestations necessitating pulmonologist's attention are not infrequent. Bony involvement of the thoracic cage is the most typical thoracic manifestation of multiple myeloma, whereas less common presentations include pneumonia, pleural effusion, intraparenchymal mass lesions, lymphadenopathy of the mediastinum, reticulonodular shadows, and intrapulmonary calcifications. Myelomatous involvement of pleura with pleural effusions is very uncommon as is extramedullary plasmacytomas involving the mediastinum. We describe the case of an elderly female with multiple myeloma on chemotherapy who developed both these thoracic manifestations simultaneously. Considering her advanced age and poor performance status, family opted for the best supportive care and she succumbed to her primary disease.