A case of a 71-year-old man diagnosed with Waldenström's macroglobulinemia
This is a rare disease affecting two types of B cells. It is characterized by having high levels of a circulating antibody, immunoglobulin M (IgM), which is made and secreted by the cells involved in the disease. The patient was treated with rituximab and therapeutic plasma exchange but was lost to follow-up after hospital discharge. Four months later, he presented with altered mental status and progressive ischemic injury of the toes, the fingers, the superior aspect of the ears, and the tip of the nose, probably related to hyperviscosity and cryoglobulinemic vasculitis. He required amputation of the digits and since presentation about 1 year ago has been treated with intravenous immunoglobulin, rituximab, and therapeutic plasma exchange. While the disease is incurable, it is treatable. Because of its indolent nature, many patients are able to lead active lives, and when treatment is required, may experience years of symptom-free remission. FOLLOW us @medicalpedia more extreme medical cases! Credit: New England Journal of Medicine
