Introduction:
Multiple myeloma (MM) is a B cell neoplasm characterized by the clonal
proliferation of neoplastic plasma cells in the bone marrow.
[1] [2]
It accounts for roughly 2 percent of all cancers and about 17 % of all
hematological malignancies with an incidence rate of 7.1 % cases per
100,000 per year. Extramedullary involvement outside the bone marrow is
frequently seen in advanced or refractory stages of multiple myeloma due
to plasma cell infiltration of visceral organs.
[3] [4]
Malignant myelomatous pleural effusion or ascites is suggestive of a
more advanced and aggressive disease and is seen in less than 1 % of
myeloma cases. [5]
[6] Ascites in MM can develop due to
peritoneal infiltration or secondary causes such as hepatic amyloidosis,
cardiac or renal diseases, or portal hypertension.
[7] Infectious peritonitis due to
tuberculosis and spontaneous bacterial peritonitis (SBP) can also be an
intrinsic secondary cause of ascites but is usually differentiated from
malignant plasmacytic ascites based on an ascitic fluid cytology
analysis. [8]
[9] Since the atypical plasma cells
detected on cytology of the fluid might appear similar to reactive
mesothelial cells, further testing methods such as flow cytometry,
immunofluorescence, or electron microscopy should be employed.
[8] Herein, we describe a case of
malignant plasmacytic ascites and pleural effusion that was initially
treated as SBP.