an unusual presentation of plasma cell leukemia with undiagnosed multiple myeloma

a 54 year old man with history of cardiomyopathy and chronic fibrillation first presented with bloody diarrhea. then during the assessment of his abnormal lab. data revealed cast nephropathy in renal biopsy, gamma peak in protein electrophoresis and fine lytic lesions in skull graphy. his bone marrow aspiration showed multiple myeloma and blood smear revealed plasma cell leukemia. our patient was diagnosed to have multiple myeloma and plasma cell leukemia plasma cell leukemia is a rare form of plasma cell dyscrasia.the second type evolves as a terminal event in some of the patients with multiple myeloma. pcl and multiple myeloma simultaneously recognizes in this case(very rare event).