Renal and Extramedullary Involvement Revealing Atypical Multiple Myeloma: A Case Report and a Literature Review

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Published Apr 1, 2026
https://doi.org/10.62438/tunismed.v104i02.6519
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Vol. 104 No. 02 (2026): Tunis Med Fev 2026

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Zohra EL Ati
Department of Nephrology, University Hospital of Tahar Sfar Mahdia, Faculty of Medicine of Monastir, University of Monastir, Tunisia
Asma Hadhri
Department of Nephrology, University Hospital of Tahar Sfar Mahdia, Faculty of Medicine of Monastir, University of Monastir, Tunisia
Rihem Dahmane
Department of Nephrology, University Hospital of Sahloul Sousse, Research Laboratory LR12SP09 'Heart Failure' , Farhat HACHED University Hospital, Sousse,  Faculty of Medicine of Sousse, University of Sousse, TunisiaTunisia
Amel Ayed
Department of Nephrology, University Hospital of Tahar Sfar Mahdia, Faculty of Medicine of Monastir, University of Monastir, Tunisia
Mayssa Hadj Brahim
Department of Nephrology, University Hospital of Tahar Sfar Mahdia, Faculty of Medicine of Monastir, University of Monastir, Tunisia
Raja Boukadida
Department of Nephrology, University Hospital of Sahloul Sousse,  Faculty of Medicine of Sousse, University of Sousse, TunisiaTunisia
Karim Zouaghi
Department of Nephrology , University Hospital of La Rabta Tunis, Faculty of Medicine of Tunis, University of Tunis, Tunisia
Lazhar Jaballah
Department of Nephrology, University Hospital of Tahar Sfar Mahdia, Faculty of Medicine of Monastir, University of Monastir, Tunisia
Lamia Raies
Department of Nephrology , University Hospital of La Rabta Tunis, Faculty of Medicine of Tunis, University of Tunis, Tunisia

Abstract

Background: Multiple myeloma (MM) is a plasma cell malignancy with diverse clinical manifestations. Beyond the classic CRAB features
(hypercalcemia, renal insufficiency, anemia, and lytic bone lesions), extramedullary involvement is rare and often life-threatening. This case
highlighted atypical and severe pulmonary–pleural manifestations, emphasizing the diagnostic complexity of extramedullary disease.
Case presentation: A 67-year-old hypertensive man was admitted with fever, dyspnea, and hemoptysis. He presented with pleural effusion,
biologically confirmed alveolar hemorrhage, nephrotic-range proteinuria, and osteolytic lesions. Cytology demonstrated pleural plasmacytic
infiltration, and bone marrow aspiration showed 100% plasmacytosis. He was diagnosed with immunoglobulin G-kappa MM with pulmonary and
pleural extramedullary disease and achieved partial remission with melphalan-dexamethasone, maintaining clinical improvement for 12 months.
Conclusion: This case illustrated rare, severe extramedullary manifestations of MM with renal dysfunction as a key clinical clue. It underscored the importance of early recognition and comprehensive diagnostic evaluation. Prognosis remains poor in aggressive variants despite timely treatment.

Keywords:

Ascites, liver neoplasms, lung neoplasms, multiple myeloma, renal insufficiency, pleural effusion

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