Lung postmortem autopsy revealing extramedullary involvement in multiple myeloma causing acute respiratory distress syndrome.
Aurélie RavinetSébastien PerbetRomain GuièzeRichard LemalRenaud GuérinGuillaume GayraudJugurtha AlianeAymeric TremblayJulien PascalAlbane LedouxCarine ChaleteixPierre DechelotteJacques-Olivier BayJean-Etienne BazinJean-Michel ConstantinPublished in: Case reports in hematology (2014)
Pulmonary involvement with multiple myeloma is rare. We report the case of a 61-year-old man with past medical history of chronic respiratory failure with emphysema, and a known multiple myeloma (Durie and Salmon stage III B and t(4;14) translocation). Six months after diagnosis and first line of treatment, he presented acute dyspnea with interstitial lung disease. Computed tomography showed severe bullous emphysema and diffuse, patchy, multifocal infiltrations bilaterally with nodular character, small bilateral pleural effusions, mediastinal lymphadenopathy, and a known lytic lesion of the 12th vertebra. He was treated with piperacillin-tazobactam, amikacin, oseltamivir, and methylprednisolone. Finally, outcome was unfavourable. Postmortem analysis revealed diffuse and nodular infracentimetric infiltration of the lung parenchyma by neoplastic plasma cells. Physicians should be aware that acute respiratory distress syndrome not responding to treatment of common causes could be a manifestation of the disease, even with negative BAL or biopsy and could be promptly treated with salvage therapy.
Keyphrases
- acute respiratory distress syndrome
- extracorporeal membrane oxygenation
- respiratory failure
- multiple myeloma
- mechanical ventilation
- interstitial lung disease
- computed tomography
- systemic sclerosis
- idiopathic pulmonary fibrosis
- healthcare
- primary care
- intensive care unit
- rheumatoid arthritis
- pulmonary hypertension
- magnetic resonance imaging
- stem cells
- high dose
- liver failure
- low grade
- magnetic resonance
- oxidative stress
- positron emission tomography
- fine needle aspiration
- air pollution
- newly diagnosed
- case report
- cell death
- image quality
- high grade