Waldenstrom's Macroglobulinemia and Ascites: A Case Report

Area of Science:

• Hematology
• Oncology
• Internal Medicine

Background:

• Waldenstrom's disease (WM) is a lymphoplasmacytic lymphoma characterized by IgM monoclonal gammopathy and potential hyperviscosity syndrome.
• Typical WM symptoms include fatigue, weight loss, night sweats, and lymphadenopathy, often in patients with a history of monoclonal gammopathy of undetermined significance (MGUS).
• This case presents an atypical initial manifestation of WM, emphasizing diagnostic challenges in elderly patients.

Observation:

• A 73-year-old patient presented with new-onset ascites and an interportocaval lymph node mass, without prior MGUS history.
• Imaging revealed a retrocaval mass, and laboratory tests showed elevated IgM levels (2190 mg/dL) with a monoclonal protein and free kappa chains.
• Bone marrow biopsy confirmed Waldenstrom's disease (type B lymphoproliferative syndrome).

Findings:

• The patient received chemotherapy with Bendamustine (120 mg).
• Within 4 weeks, IgM levels decreased significantly.
• Ascites resolved completely following treatment, indicating therapeutic efficacy.

Implications:

• This case underscores the importance of considering atypical presentations of WM, particularly in the elderly.
• The resolution of ascites suggests a potential link between IgM levels and portal hypertension in WM, warranting further pathogenetic investigation.
• Early diagnosis and prompt treatment are crucial for managing WM and its complications.