Akutna bubrežna slabost i ekstramedularna infiltracija pluća kao inicijalne prezentacije multiplog mijeloma
Sažetak
Uvod. Bubrežna slabost u multiplom mijelomu ponekad predstavlja inicijalnu simptomatologiju i veoma ozbiljnu komplikaciju sa nepovoljnim uticajem na tok bolesti. Multipli mijelom je bolest koju karakteriše proliferacija plazmocita u koštanoj srži, a u retkim slučajevima mogu biti zastupljeni i ekstramedularno u različitim organima i sistemima. Plućna lokalizacija plazmocitoma je retka ekstramedularna lokalizacija, a pogotovo kada predstavlja i jednu od inicijalnih manifestacija multiplog mijeloma. Prikaz bolesnika. Prikazali smo bolesnika sa akutnom bubrežnom insuficijencijom, progresivnog toka, kod koga je započeto lečenje hemodijalizama. Na radiografiji grudnog koša zapažena je homogena senka uz levi lateralni zid grudnog koša, a multislajsna kompjuterizovana tomografija (MSKT) je ukazala na tumorsku formaciju u plućnom parenhimu u projekciji levog gornjeg plućnog režnja sa znacima infiltracije pleure, interkostalnih mišića i destrukcijom V rebra. Laboratorijskim ispitivanjem, osim anemijskog sindroma i azotemije sa hiperurikemijom, u urinu je dokazana Bence-Jones-ova proteinurija. Nakon bronhoskopije i iglene biopsije, u citološkom i patohistološkom nalazu pluća dokazana je difuzna infiltracija zrelih plazma ćelija. Patohistološki nalaz biopsije koštane srži ukazao je na multipli mijelom lambda tipa sa infiltracijom plazma ćelijama – oko 70%. Od strane hematologa postavljena je dijagnoza multiplog mijeloma BJ lambda III BCS, sa ekstramedularnim zahvatom pluća i akutnom bubrežnom insuficijencijom. Dalje lečenje nastavljeno je po hematološkom protokolu uz obavljanje intermitentnih hemodijaliza. Zaključak. Ponekad, izuzetno retko i kod potpuno asimptomatskih bolesnika, masivne plućne infiltracije, zapažene inicijalno, diferencijalno dijagnostički mogu predstavljati i ekstramedularnu prezentaciju multiplog mijeloma, o čemu treba razmišljati.
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