Key result
Drainage plus daratumumab-based therapy achieves complete metabolic response and effusion resolution in myelomatous cardiac tamponade.
Case Report (n=1)
No
This case demonstrates that relapsed extramedullary multiple myeloma can cause concurrent malignant pleural and pericardial effusions leading to cardiac tamponade, even when the pleural fluid appears biochemically transudative.
Malignant cells may appear in transudative effusions by Light’s criteria in myeloma; leaves open whether cytology is warranted beyond standard biochemical assessment.
A man in his 70s with relapsed IgA kappa multiple myeloma presented with dyspnoea, hypoxaemia and chest discomfort. CT showed bilateral pleural effusions, a large pericardial effusion and bulky abdominal soft tissue masses. Right thoracentesis yielded a biochemically transudative effusion by Light’s criteria, yet cytology demonstrated CD138-positive, kappa-restricted malignant plasma cells. Echocardiography showed tamponade physiology and urgent pericardiocentesis yielded haemorrhagic fluid containing CD56-positive, CD138-positive, kappa-restricted plasma cells concordant with the pleural specimen. Biopsy of a 10.8×8 cm retroperitoneal mass confirmed an extramedullary plasma cell neoplasm. Treatment with drainage and daratumumab, lenalidomide and dexamethasone was followed by complete metabolic response and resolution of the pericardial effusion. Ventricular tachycardia recurred despite radiographic disease resolution, leaving myocardial infiltration unproven. This case highlights concurrent myelomatous pleural and pericardial involvement and demonstrates that a transudative pleural fluid profile does not exclude malignant plasma cell involvement.
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Rana et al. (2026) conducted a case report in Relapsed extramedullary IgA kappa multiple myeloma with concurrent myelomatous pleural and pericardial effusions and cardiac tamponade (n=1). Fluid drainage (thoracentesis and pericardiocentesis) plus daratumumab, lenalidomide, and dexamethasone was evaluated on Metabolic response and resolution of pericardial effusion. Drainage and daratumumab, lenalidomide, and dexamethasone achieved complete metabolic response and pericardial effusion resolution in a man in his 70s with myelomatous tamponade.
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