Case of Waldenstrom Macroglobulinaemia Mimicking Multiple Myeloma: A Diagnostic Challenge

1. Postgraduate Student, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. 2. Associate Professor, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. 3. Professor, Department of Haematology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. 4. Assistant Professor, Department of Radiation Oncology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. 5. Postgraduate Student, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India.

Abstract

A rare form of lymphoplasmacytic lymphoma, Waldenstrom’s Macroglobulinaemia (WM) progresses slowly and requires treatment only when the patient exhibits symptoms. Organomegaly, cytopenia, hyperviscosity syndrome, and constitutional symptoms are the most common presentations of WM. The main affliction of the tumour is with the bone marrow, which is made up of plasma cells, tiny lymphocytes, and plasmacytoid lymphocytes. An Immunoglobulin M (IgM) gammopathy is also present in the circulating blood. Here, we describe a 77-year-old man who complained of epistaxis, hair loss, elevated serum creatinine, hypercalcaemia, and a reversal of the albumin-to-globulin ratio. Additionally, the patient showed M band positive, which led to the diagnosis of WM rather than multiple myeloma, as was first believed. Our case report highlights the importance of considering WM in the differential diagnosis of patients presenting with symptoms such as epistaxis, fatigue, weakness, and Raynaud's phenomenon, particularly in elevated serum IgM levels. Prompt recognition and diagnosis of WM are essential for appropriate management and prognosis. In summary, our case underscores the importance of vigilance in recognising the clinical manifestations of WM and the necessity of a comprehensive approach to diagnosis, treatment, and follow-up care. Further research is warranted to elucidate the underlying pathogenesis of WM and to develop more effective and targeted therapeutic strategies for this rare haematological malignancy.

Cancer, IgM, Lymphoma, Monoclonal immunoglobulin, Raynaud’s phenomenon, Waldenström macroglobulinaemia