Cancer Res Treat.  2011 Sep;43(3):199-203.

Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report

Affiliations
  • 1Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea. towersue@hotmail.com
  • 2Department of Pathology, Kosin University College of Medicine, Busan, Korea.
  • 3Department of Radiology, Kosin University College of Medicine, Busan, Korea.
  • 4Department of Laboratory Medicine, Kosin University College of Medicine, Busan, Korea.

Abstract

Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of > or =0.5x10(9)/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.

Keyword

Eosinophilia; Multiple myeloma; Autologous transplantation

MeSH Terms

Adult
Eosinophilia
Eosinophils
Hematopoietic Stem Cells
Humans
Hypereosinophilic Syndrome
Multiple Myeloma
Stem Cell Transplantation
Stem Cells
Transplantation, Autologous

Figure

  • Fig. 1 (A) A bone marrow biopsy showed hypercellular marrow (>90%) with numerous eosinophils and plasma cells (H&E staining,×1,000). (B) Bone marrow aspiration revealed hypercellular marrow with many eosinophils and plasma cells (Wright staining,×1,000).

  • Fig. 2 (A) A right pleural effusion was noted, with focal consolidation or subsegmental atelectasis of the right middle lobe. (B, C) Hepatosplenomegaly of both hepatic lobes was present without a definite focal lesion. The perihepatic space contained fluid. The lymph nodes were enlarged in the peripancreatic, mesenteric and aortocaval areas. (D) Minimal pericardial effusion, septal hypertrophy and mild global hypokinesia of the left ventricle were noted on echocardiography. (E) There was a relaxation abnormality in the mitral valve inflow pattern. (F) Diffuse-fashioned erythema of the mucosa was noted in the antrum of the stomach.

  • Fig. 3 (A) The liver parenchyme showed infiltrations of numerous eosinophils and plasma cells on the hemorrhage focus (H&E staining,×200). (B) The liver parenchyme and portal areas showed infiltration of eosinophils and plasma cells on the hemorrhage foci (H&E staining,×400). (C, D) Plasma cells and eosinophils were observed in the pleural fluid and the ascitic fluid (D) (H&E staining, C,×1,000; D,×1,000).

  • Fig. 4 Flow cytometric detection of plasma cells. Identification of plasma cells in pleural and peritoneal fluids of the patient using the plasma cell markers CD38 and CD138. These cells are high-intensity CD38-positive and CD138-positive. (A) Plasma cell markers were positive (CD138, 60.12%; CD38, 96.2%) in the peritoneal fluid. (B) Plasma cell markers were positive (CD138, 96.18%; CD38, 99.8%) in the pleural fluid.

  • Fig. 5 (A) A monoclonal peak is observed in the gammaglobulin fraction (7.73 g/dL) in serum protein electrophoresis. (B) IgG (G), kappa (κ), and lambda (λ) lanes were identified in serum immunofixation electrophoresis. SP, standard protein; A, IgA; M, IgM.


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