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An Extremely Rare Cause of Protein-Losing Enteropathy: Waldenström Macroglobulinemia

Omar Saab1, Marwah Algodi2, Hasan Al-Obaidi3

  • 1Hospital Medicine Department, Cleveland Clinic, Cleveland, OH.

ACG Case Reports Journal
|August 5, 2025
PubMed

Insights

Waldenström macroglobulinemia (WM) can cause protein-losing enteropathy (PLE) by depositing immunoglobulin M (IgM) in the small bowel. Consider WM in unexplained PLE cases with gastrointestinal symptoms and high IgM.

Area of Science:

  • Gastroenterology
  • Hematology
  • Oncology

Background:

  • Protein-losing enteropathy (PLE) is characterized by excessive protein loss via the gastrointestinal tract, leading to malabsorption and hypoalbuminemia.
  • Waldenström macroglobulinemia (WM) is a rare hematological malignancy associated with immunoglobulin M (IgM) monoclonal gammopathy.

Observation:

  • A 66-year-old male presented with worsening gastrointestinal symptoms, weight loss, and anasarca.
  • Endoscopic evaluation revealed lymphangiectasia-like changes, and biopsies showed proteinaceous material and IgM deposition in the small bowel villi.

Findings:

  • Laboratory results indicated hypoproteinemia, hypoalbuminemia, and elevated IgM levels.
  • Bone marrow biopsy confirmed the diagnosis of Waldenström macroglobulinemia (WM).

Implications:

  • This case highlights WM as a potential, albeit rare, cause of unexplained PLE.
  • Elevated IgM levels and gastrointestinal symptoms warrant consideration of WM in the differential diagnosis of PLE.
Keywords:
Waldenström macroglobulinemiacase reportgastroenterologyliterature reviewprotein-losing enteropathy

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