Waldenstroms Macroglobulinemia Patient Presenting with Rare 'lytic' Lesions and Hypercalcemia: A Diagnostic Dilemma

Waldenstroms macroglobulinemia (WM) is an uncommon B-cell lymphoproliferative neoplasm characterized by lymphoplasmacytic cells infiltrating the Bone Marrow, along with demonstration of an IgM monoclonal gammopathy in the serum. Lytic lesions are considered one of the basis for differentiating a patient of Multiple Myeloma (MM) and WM. However, very few cases have been reported with a patient presenting with lytic lesions in a WM patient, thereby, complicating the disease. By finding the extent of these lytic lesions and bone involvement, Not only can we signify the presence or absence of bone lesions, but we can also direct the more efficient use of skeletal X-rays for documentation of the extent, location, and response of bone abnormalities to interventional chemotherapy and radiation therapy. Our case was mimicking the classic case of MM. Using the International Criteria for diagnosis for WM, diagnosis for MM was excluded and diagnosis for WM was made. After two weeks of therapy, the patient showed marked clinical improvement.