DIAGNOSIS AND TREATMENT OF PNEUMONIA IN PATIENTS WITH MULTIPLE MYELOMA

Abstract

The peculiarities of pneumonia in patients with multiple myeloma (MM) were studied. It was found out that pneumonia is a frequent complication of MM (33 patients out of 123 examined ones – 26.8%). Most cases of pneumonia developed in the presence of chronic renal failure and/or agranulocytosis. Pneumonia had a severe course in 61% of MM patients. Diagnosis of pneumonia in patients with MM occurring against agranulocytosis is very difficult as due to the deficiency of granulocytes a clear inflammatory focus which gives a classical physical and radiological picture is not formed in the lungs of these patients. In patients with MM there is a high percentage of nosocomial pneumonia (39%). A severe, prolonged and atypical course of pneumonia in MM is conditioned by granulocytopenia, secondary immunodeficiency, impaired lung excursions due to the deformation of the chest, mielomatose lung affection (paraproteinosis, lymphoid and plasma cell infiltration of the lungs and bronchi, pulmonary fibrosis, emphysema, amyloidosis, mielomatose pleura affection), specific pulmonary manifestations of uremia (nephrogenic edema, uremic pneumonitis and calcification). In accordance with pneumonia occurrence in hospital or out of it, a probable pathogen, clinic-pathogenetic situation, the presence of complications and disorders, a baseline algorithm of empirical treatment of pneumonia in patients with MM was worked out prior to the detection of the pathogen and of its sensitivity to antibiotics as well as for those situations when etiologic diagnosis of pneumonia is not possible.