Waldenström’s macroglobulinemia (WM) is a distinct clinicopathologic entity characterized by the presence of lymphoplasmacytic lymphoma (LPL) in the bone marrow and IgM monoclonal gammopathy in the blood, with diverse clinical presentations, including cytopenias linked to bone marrow infiltration, hyperviscosity syndrome, fever, lymphadenopathy, and recurrent infections. We report a case of a patient who was diagnosed as having WM after he presented with a deep cervical abscess, which resulted in death.
The patient was a 72-year-old man who visited our emergency department with a one-month history of anorexia, 2-week history of weakness in the lower extremities, and a day’s history of fever. Blood examination revealed high levels of inflammatory response markers and he was urgently admitted and started on treatment with intravenous antibiotics at the department of internal medicine. The following day, computed tomography (CT) revealed a deep cervical abscess, and the patient was transferred to the otolaryngology department, where an incisional drainage procedure was performed under local anesthesia. On the fifth day of hospitalization, expansion of the abscess cavity necessitated incision and drainage under general anesthesia. On day 14th of hospitalization, the patient again developed fever and increased levels of inflammatory response markers, and CT showed pneumonia, although the abscess cavity had reduced in size. On the 19th day of hospitalization, anemia and thrombocytopenia became clinically apparent. On the 22nd day of hospitalization, the inflammatory response marker levels had improved, but the patient continued to have fever and developed impaired consciousness, and he was referred to an internist. On day 35 of hospitalization, the patient was diagnosed as having WM based on increased levels of M protein and findings on bone marrow biopsy. Because of the patient’s poor general condition, he was started on steroid treatment, while chemotherapy was withheld. Unfortunately, however, his condition began to deteriorate rapidly and he died two days later.
In patients with a deep cervical abscess without underlying diseases such as diabetes, the possibility of underlying hematological disorders associated with immunosuppression or increased vulnerability to infections, such as WM, should be borne mind.
