Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2024; 12(22): 5196-5207
Published online Aug 6, 2024. doi: 10.12998/wjcc.v12.i22.5196
Pleural effusion, ascites, colon ulcers and hematochezia: What we can learn from the diagnostic process of a patient with plasma cell myeloma: A case report
Ming-Xian Yan
Ming-Xian Yan, Department of Gastroenterology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China
Author contributions: Dr. Yan MX contributed to data collection, writing, and revision of the manuscript.
Informed consent statement: This article does not contain personal information that would allow the patient described to be identified, which makes both authorization from the institution’s ethics committee and the patient’s informed consent unnecessary for the publication of the article.
Conflict-of-interest statement: The author declares no conflicts of interest regarding the publication of this article.
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Corresponding author: Ming-Xian Yan, MD, PhD, Chief Physician, Department of Gastroenterology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Jinan 250014, Shandong Province, China. yanmingxian@sdfmu.edu.cn
Received: April 6, 2024
Revised: May 24, 2024
Accepted: June 12, 2024
Published online: August 6, 2024
Processing time: 86 Days and 21.3 Hours
Abstract
BACKGROUND

Plasma cell myeloma (PCM) is characterized by hypercalcemia, renal impairment, anemia, and bone destruction. While pleural effusion, ascites, abdominal pain, and bloody stool are common manifestations of lung disease or gastrointestinal disorders, they are rarely observed in patients with PCM.

CASE SUMMARY

A 66-year-old woman presented with complaints of recurrent chest tightness, wheezing, and abdominal bloating accompanied by bloody stools. Computed tomography revealed pleural effusion and ascites. Pleural effusion tests showed inflammation, but the T-cell spot test and carcinoembryonic antigen were negative. Endoscopy showed colonic mucosal edema with ulcer formation and local intestinal lumen stenosis. Echocardiography revealed enlarged atria and reduced left ventricular systolic function. The diagnosis remained unclear. Further testing revealed elevated blood light chain lambda and urine immunoglobulin levels. Blood immunofixation electrophoresis was positive for immunoglobulin G lambda type. Smear cytology of the bone marrow showed a high proportion of plasma cells, accounting for about 4.5%. Histopathological examination of the bone marrow suggested PCM. Flow cytometry showed abnormal plasma cells with strong expression of CD38, CD138, cLambda, CD28, CD200, and CD117. Fluorescence in situ hybridization gene testing of the bone marrow suggested 1q21 gene amplification, but cytogenetic testing showed no clonal abnormalities. Colonic mucosa and bone marrow biopsy tissues were negative for Highman Congo red staining. The patient was finally diagnosed with PCM.

CONCLUSION

A diagnosis of PCM should be considered in older patients with pleural effusion, ascites, and multi-organ injury.

Keywords: Plasma cell myeloma; Pleural effusion; Ascites; Hematochezia; Colon ulcers; Bone marrow aspirate; Case report

Core Tip: Plasma cell myeloma is a common hematologic disorder that typically presents with hypocalcemia, anemia, kidney damage, and bone destruction. However, some patients present it atypically, with symptoms from other systems as the main manifestation, making the diagnosis difficult. For patients with complex presentations, necessary tests should be gradually refined through a multidisciplinary approach to obtain an accurate diagnosis. Clinicians need to accumulate clinical experience to effectively diagnose such difficult cases.