Acute kidney failure and extramedullary lung infiltration as the initial presentation of multiple myeloma: A case report

Violeta  Rabrenović; Bojan Nikolić; Milorad Rabrenović; Milica Petrović; Ana Milojević; Vesna Škuletić; Dragan  Živojinović; Dragan  Dulović; Marko  Stojisavljević; Svetlana  Mirosavljević; Saša  Ristić; Miloje  Pantović; Marijana  Petrović; Katarina  Obrenčević; Dejan  Pilčević; Nemanja  Rančić

doi:10.2298/VSP190119056R

Violeta Rabrenović Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
Bojan Nikolić Military Medical Academy, Institute of Radiology, Belgrade, Serbia
Milorad Rabrenović Military Medical Academy, Center for Hyperbaric Medicine, Belgrade, Serbia
Milica Petrović Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
Ana Milojević Military Medical Academy, Institute of Medical Biochemistry, Belgrade, Serbia
Vesna Škuletić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Dragan Živojinović Military Medical Academy, Institute of Pathology, Belgrade, Serbia
Dragan Dulović Military Medical Academy, Institute of Radiology, Belgrade, Serbia
Marko Stojisavljević Military Medical Academy, Clinic for Pulmonology, Belgrade, Serbia
Svetlana Mirosavljević Military Medical Academy, Clinic for Hematology, Belgrade, Serbia
Saša Ristić Military Medical Academy, Institute of Pathology, Belgrade, Serbia
Miloje Pantović Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
Marijana Petrović Military Medical Academy, Clinic for Nephrology Belgrade, Serbia
Katarina Obrenčević Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
Dejan Pilčević Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
Nemanja Rančić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP190119056R

Keywords: multiple myeloma, lung, acute kidney injury, diagnosis, differential

Abstract

Introduction. Kidney failure in multiple myeloma is sometimes initial symptomatology and a very serious complication with an unfavorable effect on the course and prognosis of the disease. Multiple myeloma is a disease characterized by the proliferation of plasmocytes in the bone marrow, and in rare cases, it can be extramedullary in various organs and systems. Pulmonary plasmacytoma localization is a rare extramedullary localization, especially when it represents one of the initial manifestations of multiple myeloma. Case report. We present a patient with progressive acute kidney failure who has started hemodialysis treatment. On chest radiography, a homogeneous shadow was observed along the left chest wall, and the multislice computed tomography (MSCT) pointed to the tumor formation in the pulmonary parenchyma in the projection of the left upper pulmonary lobe with signs of pleural infiltration, intercostal muscles, and V rib destruction. Laboratory examination indicated the presence of Bence-Jones proteinuria in the urine sample in addition to anemia syndrome and azotemia with hyperuricemia. After bronchoscopy and needle biopsy, diffuse infiltration of mature plasma cells was demonstrated in the cytological and histopathological findings of the lungs. The histopathological finding of bone marrow biopsy indicated multiple myeloma of Lambda type with infiltration of plasma cells – about 70%. The hematologist determined a diagnosis of multiple myeloma BJ lambda III BCS, with extramedullary lung infiltration and acute kidney failure. Further treatment was continued according to the hematological protocol while performing intermittent hemodialysis. Conclusion. Sometimes, extremely rarely, and in completely asymptomatic patients with massive pulmonary infiltration observed initially, the differential diagnosis may also represent an extramedullary presentation of multiple myeloma, which should be considered.

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