Indian Journal of Pathology and Microbiology
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  Table of Contents    
LETTER TO EDITOR  
Year : 2022  |  Volume : 65  |  Issue : 4  |  Page : 955-956
An unwelcome guest in a patient of myeloma


Department of Hematology, All India Institute of Medical Sciences, New Delhi, India

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Date of Submission10-May-2021
Date of Decision21-May-2021
Date of Acceptance21-May-2021
Date of Web Publication26-May-2022
 

How to cite this article:
Khare A, K. Sahitya DS, Dass J, Aggarwal M. An unwelcome guest in a patient of myeloma. Indian J Pathol Microbiol 2022;65:955-6

How to cite this URL:
Khare A, K. Sahitya DS, Dass J, Aggarwal M. An unwelcome guest in a patient of myeloma. Indian J Pathol Microbiol [serial online] 2022 [cited 2022 Dec 7];65:955-6. Available from: https://www.ijpmonline.org/text.asp?2022/65/4/955/345872




A 49-year-old male presented with complaints of low backache since 6 months along with difficulty in sitting and walking for the past 1 month. X-ray pelvis and hip showed multiple punched out lytic lesions. Magnetic resonance imaging of whole spine revealed collapse of multiple thoracic vertebral bodies.

The haemoglobin was 74 g/L, total leucocyte count was 5.98 × 109/L, and platelet count was 216 × 109/L. Jenner-Giemsa-stained peripheral smear showed marked rouleaux formation along with occasional circulating plasma cells and microfilariae of Wuchereria bancrofti without any eosinophilia [Figure 1]a. Bone marrow aspirate smears revealed ~35% plasma cells with many showing Auer rod like inclusions [Figure 1]b and [Figure 1]c. Microfilariae were seen on bone marrow aspirate smears as well [Figure 1]d. These inclusions were positive for Non-specific esterase (NSE) [[Figure 1]c, inset] and negative for Myeloperoxidase. Total protein was 10.6 g/dL with albumin of 2.3 g/dL and globulins of 8.3 g/dL. A: G ratio was 0.27. Serum creatinine and calcium were normal. Serum protein electrophoresis and immunofixation showed IgGκ monoclonal band measuring 6.3 g/dL in the gamma region. The case was diagnosed as plasma cell myeloma with incidentally detected microfilariae.
Figure 1: (a): Peripheral smear showing microfilaria along with marked rouleaux (Jenner Giemsa, ×400). (b): Bone marrow aspirate smear showing increased plasma cells many of which show Auer rod like inclusions (Jenner Giemsa, ×400). (c): Bone marrow aspirate smear, higher power showing a plasma cell with Auer rod like inclusions (Jenner Giemsa, ×1000) positive for NSE (Inset- Non-specific esterase stain, ×1000). (d): Bone marrow aspirate smear showing microfilaria along with plasma cells (Jenner Giemsa, ×400)

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Presence of microfilariae in association with multiple myeloma is very rare. PubMed search reveals only two cases of microfilaria along with plasma cell myeloma in bone marrow smears.[1],[2] In addition, Kerketta et al.,[3] described four cases where microfilariae were detected during conventional karyotyping in a series of 209 haematological malignancies. These included two cases of myeloma with microfilariae of B. malayi, but their peripheral blood and bone marrow aspirate smears did not show microfilariae. Microfilariae also escaped detection on Knott's concentration method in three of the four cases described.

Patients of myeloma have a higher rate of infection compared to general population due to immunodeficiency that involves B-cell dysfunction, such as hypogammaglobulinemia, as well as T-cell, NK cells and dendritic cell abnormalities. Most of the infections are bacterial and viral but parasitic infections are rare.[4] Co-existence of microfilariae has been reported in many cancers, whether these patients are more prone to filarial infection due to their immunocompromised status or whether these parasites are accidental passengers in the tissues is unclear and needs to be evaluated.[5]

In our case, microfilaria was an incidental finding in a symptomatic myeloma and patient had no symptoms related to filariasis. Presence of microfilaria in a case of myeloma requires specific anti-parasitic treatment along with management of myeloma, to decrease the associated morbidity. Careful evaluation of the bone marrow smears is important to identify coexisting pathologies including parasitic infestations apart from the primary pathology, as highlighted in our case. This case underscores the importance of screening the bone marrow aspirate slides carefully for parasitic infections in endemic regions.

Author contributions

Dr. Akriti and Dr Sahitya worked up the case and wrote the manuscript. Dr. Jasmita performed the literature review and reviewed the manuscript. Dr. Mukul reviewed the manuscript and treated the patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kolte S, Mane P. Microfilaria of Wuchereria bancrofti in plasma cell myeloma: A case report. J Vector Borne Dis 2015;52:342.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Sharma S, Mannan R, Sharma R, Sharma SC. Co-existence of Wuchereria bancrofti microfilaraemia in a case of multiple myeloma: An incidental finding or an association? J Clin Diagn Res 2017;11:ED06-8.  Back to cited text no. 2
    
3.
Kerketta LS, Rao VB, Ghosh K. Standard karyotyping concentrates microfilaria and can be a valid concentrating technique for their detection. Trop Med Int Health 2012;17:1222-6.  Back to cited text no. 3
    
4.
Blimark C, Holmberg E, Mellqvist U-H, Landgren O, Bjorkholm M, Hultcrantz M, et al. Multiple myeloma and infections: A population-based study on 9253 multiple myeloma patients. Haematologica 2015;100:107-13.  Back to cited text no. 4
    
5.
Kerketta LS, Ghosh K. Circulating microfilariae in haematological malignancies: Do they have a role in pathogenesis? J Helminthol 2018;92:125-7.  Back to cited text no. 5
    

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Correspondence Address:
Jasmita Dass
Assistant Professor, Department of Hematology, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpm.ijpm_458_21

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