Fast Five Quiz: Can You Diagnose Waldenström Macroglobulinemia?

Emmanuel C. Besa, MD


March 13, 2019

Some of the common presenting clinical signs and symptoms of WM are similar to those of MM (eg, fatigue, weakness, weight loss, anemia). However, there are other signs and symptoms that help clinicians differentiate WM from MM. Organomegaly, a common presenting sign of patients with WM, is an uncommon presentation in patients with MM. Conversely, lytic bony and renal diseases are common presentations in patients with MM but are uncommon in patients with WM.

It is important to note that approximately 25% of patients with WM are asymptomatic. In this patient population, WM is often an incidental finding—one typically discovered through blood work performed for a routine physical exam.

WM should be considered in patients presenting with weakness, anorexia, weight loss, and symptoms of Raynaud phenomenon. Common physical exam findings of WM include hepatosplenomegaly, lymphadenopathy, purpura, and neuropathy.

In patients with WM, central nervous system infiltration by the B-cell clone often results in altered mental status, including lethargy and coma. Malignant lymphoplasmacytic cell involvement can also lead to Bing-Neel syndrome, a rare disease manifestation of WM that causes confusion, memory loss, disorientation, and motor abnormalities. Bing-Neel syndrome can develop in patients with known WM and in previously undiagnosed patients—even in the absence of systemic progression. Signs and symptoms of life-threatening HVS include abnormal bleeding, dizziness, headache, blurry vision, and hearing or vision disturbances.

The clinical presenting signs and symptoms associated with fibromyalgia, metastatic colon cancer, and Parkinson disease do not mimic those of WM and are not included in the differential diagnosis.

For more on the clinical presentation of WM, read here.


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