Cytological Diagnosis of Multiple Myeloma Presenting as Unilateral Pleural Effusion:A Rare Case Report

Multiple myeloma presenting as a pleural effusion is extremely rare. Generally, it is a late complication which is associated with a poor prognosis. A 58-year old male presented with severe weakness, palpitation on exertion, dyspnea and fever for last four months. Clinically he was diagnosed as pulmonary tuberculosis. Chest radiograph showed left sided pleural effusion. Pleural cytology revealed numerous plasma cells, consisting of mature and immature - binucleated and atypical types. Cytological differential diagnosis included myelomatous effusion and immunoblastic type non-Hodgkin's lymphoma. Bone marrow biopsy and serum protein electrophoresis confirmed the diagnosis as plasmoblastic type multiple myeloma. Although extremely rare, Myelomatous pleural effusion as an initial presentation should always be considered in presence of atypical plasma cells in body fluids irrespective of age.