Case 20-1987 — A 45-Year-Old Dairy Farmer with Plasma-Cell Leukemia and a Recent Pulmonary Infiltrate

Presentation of CaseA 45-year-old man was admitted to the hospital because of plasma-cell leukemia and renal failure.He was well until 21 months earlier, when he incurred a compression fracture of the third lumbar vertebra in a fall. Evidence of a pathologic fracture was found. A peripheral-blood smear showed rouleaux formation. A bone marrow aspiration revealed sheets of mature and immature plasma cells (Fig. 1). A diagnosis of multiple myeloma was made. Radiation treatment was administered to the spine, and the patient received cyclic chemotherapy with vincristine, melphalan, cyclophosphamide, doxorubicin, and prednisone. His condition was satisfactory during the next . . .