Macrocryogelglobulinemia; Report of a Case with Unusual Spontaneous Recovery

Abstract

A case of clinical Waldenström’s macroglobulinemia associated with cryogelglobulin of S20w9.8 is described, and the clinical and laboratory features of the macroglobulinemias commented on. The presence of a defect in renal concentrating ability corresponding to the degree of serum viscosity is reported. There was complete spontaneous remission.

Case Details

Personal Characteristics

57-year-old negro man, well-nourished, muscular

Clinical Characteristics

Disorientation, confusion, anterior chest pain, dyspnea on exertion, dizziness, blurred vision, bleeding gums, hemoptysis, impotency, mild weakness, syncopal episode with cardiovascular collapse, stuporous, maculopapular, seborrheic rash, dilated and reactive pupils, conjunctival hemorrhages, optic fundi demonstrated fresh flame-shaped hemorrhages with venous engorgement and beading and a few small, soft exudates, lymph nodes palpated in the left posterior cervical area, accentuation of the second sound with physiologic splitting in the pulmonic area, systolic ejection murmur, prominent venous pattern, slight abdominal distention, smooth liver edge, splenic tip, impairment of memory, judgment and mentation, confusion, poor orientation

Remission Characteristics

Mental symptoms subsided, gingival bleeding stopped, no evidence of cardiovascular, hematological or neurological disease, optic fundi demonstrated almost complete regression of the initial lesions

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Bed rest, fluid and caloric supplements, oral administration of 300 milligrams of ferrous sulfate daily, plasmapheresis

Additional Notes

The patient had a complete spontaneous remission. The patient was asymptomatic with no physical abnormalities, although still lethargic at the time of transfer to a lodging home. The patient returned to the medical clinic with complaints of low back pain which developed after he had done heavy lifting three weeks previously. On readmission the patient was lethargic, slightly confused and mentally dull, but oriented and well-maintained. The patients clinical course following the second admission was unremarkable. The back pain responded to symptomatic therapy. He was asymptomatic except for lethargy and mental dullness and was discharged to a medical clinic. Re-examination revealed no abnormalities and protein studies were completely normal.