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A Man with Paraneoplastic Retinopathy plus Small Fiber Polyneuropathy Associated with Waldenström Macroglobulinemia (Lymphoplasmacytic Lymphoma): Insights into Mechanisms.
[waldenström macroglobulinemia]
Abstract
Purpose
:
To
report
a
well-characterized
Waldenström
's
macroglobulinemia
(
WM
)
case
that
provides
insight
into
the
mechanisms
of
two
paraneoplastic
complications
-
-
cancer-associated
retinopathy
(
CAR
)
and
small
fiber
polyneuropathy
(
SFPN
)
.
Methods
:
Retrospective
medical
chart
review
.
Results
:
A
58
-
year
old
man
with
WM
developed
vision
loss
and
bilateral
lower
extremity
pain
.
CAR
was
diagnosed
by
history
,
a
depressed
electroretinogram
(
ERG
)
and
positive
anti-
retinal
antibodies
.
SFPN
diagnosis
was
based
on
abnormal
autonomic
nerve
function
testing
and
a
distal
-
leg
skin
biopsy
that
demonstrated
absent
epidermal
small
-fiber
innervation
,
IgM
and
complement
deposition
and
microvasculopathy
.
Plasma
exchange
(
PLEX
)
led
to
dramatic
pain
relief
and
subjective
improvement
in
eye
symptoms
along
with
improvement
of
some
ERG
parameters
.
Repeat
skin
biopsy
after
treatment
showed
less
microvascular
abnormalities
and
decreased
complement
deposition
.
Conclusions
:
The
concurrence
of
CAR
and
SFPN
in
this
patient
suggest
that
both
were
complications
of
WM
and
their
common
response
to
PLEX
suggests
co
-mediation
by
humoral
factors
that
accessed
target
antigens
through
IgM-triggered
,
complement-mediated
vascular
damage
.
Diseases
Validation
Diseases presenting
"eye symptoms"
symptom
hirschsprung disease
waldenström macroglobulinemia
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