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Case Reports in Hematology
Volume 2017 (2017), Article ID 3732902, 6 pages
https://doi.org/10.1155/2017/3732902
Case Report

Waldenstrom’s Macroglobulinemia: A Report of Two Cases, One with Severe Retinopathy and One with Renal Failure

1Division of Hematology, Takasago-seibu Hospital, Takasago 676-0812, Japan
2Department of Internal Medicine, Uji-Tokushukai Medical Center, Uji 611-0042, Japan
3The Center for Hematological Diseases, Takeda General Hospital, Kyoto 601-1495, Japan
4Division of Ophthalmology, Takasago-seibu Hospital, Takasago 676-0812, Japan
5Department of Urology, Uji-Tokushukai Medical Center, Uji 611-0042, Japan
6Department of Pathology, Uji-Tokushukai Medical Center, Uji 611-0042, Japan
7Department of Laboratory Medicine, Uji-Tokushukai Medical Center, Uji 611-0042, Japan

Correspondence should be addressed to Shinsaku Imashuku; pj.ro.teni-otoyk.xobm@59minihs

Received 25 June 2017; Revised 16 September 2017; Accepted 3 October 2017; Published 31 October 2017

Academic Editor: Sergio Storti

Copyright © 2017 Naoko Kudo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report here two cases of Waldenstrom’s macroglobulinemia (WM), one with central nervous system (CNS) symptoms and severe retinopathy and one with renal failure. In both cases, the serum IgM levels exceeded 3,000 mg/dL and monoclonal IgM-kappa was observed in the blood. At onset, Case 1, a 63-year-old female, developed CNS symptoms—namely, drowsiness and syncope. Case 2, a 58-year-old male, had nausea and dysgeusia on admission associated with renal failure, which is quite rare in patients with WM. Both patients exhibited hyperviscosity-related retinopathy, but it was particularly severe in Case 1: she suddenly lost her vision after admission. However, her vision recovered completely during treatment. Case 2 required hemodialysis immediately after admission. Needle biopsy of his kidney revealed tubulointerstitial nephritis with marked infiltration with CD20-positive lymphoplasmacytic lymphoma cells. After treatment, Case 1 has been in a remission longer than 8 years, but Case 2 died of pneumonia in 6 months. Since the initial symptoms of WM are ambiguous and vary significantly and hyperviscosity-related ophthalmological problems or severe renal dysfunction can arise, it is essential to promptly measure serum IgM levels and to institute appropriate care immediately when WM is confirmed in a patient.