Abstract

Multiple myeloma is a low malignant, non-Hodgkin's lymphoma, which is characterized by infiltration of the bone marrow by clonal proliferation of atypical plasma cells. Extramedullary manifestations are relatively rare. Serous effusions in multiple myeloma are uncommon (6% of cases) but a myelomatous pleural effusion occurring in these patients is extremely rare. Plasma cell leukemia, occurring either de novo or in patients with long standing multiple myeloma, is the least common type of plasma cell dyscrasia. The authors describe the course of plasmacellular leukemia in a 63-year-old male patient where the first manifestation of the disease was a bacteremic pneumococcal pneumonia and a contralateral pleural exúdate with a cytological finding of plasma cells. The exúdate disappeared after the first cycle of chemotherapy (vincristine, adriamycin, dexamethasone). After the third cycle of chemotherapy remission ofithe disease was recorded which was, however, short. After three months' remission the disease recurred, consequently underwent autologous bone marrow transplantation. The patient has maintained complete remission fior 12 months after diagnosis. Pleural effusion is an unusual but important complication of multiple myeloma and does not necessarily carry the grave prognosis implied in previous reports.