A rare cause of pulmonary opacities: Lung localization of Waldenstrom's macroglobulinemia

Introduction. - Pulmonary localized forms of Waldenstrom's macroglobulinemia are rare. Case report. - We report the observation of a 71-year-old woman with chronic cough and persisting alveolar opacities after several courses of antibiotics. Physical examination was unremarkable. Protein electrophoresis identified a monoclonal IgM in the serum. The lymphocyte immunophenotyping from the bronchoalveolar lavage was consistent with a B-cell lymphoma and Waldenstrom's macroglobulinemia was confirmed by the bone marrow biopsy. Chemotherapy with a combination of rituximab, fludarabine and cyclophosphamide improved the patient's symptoms and caused the pulmonary opacities to resolve. We discuss the various clinical and radiological pulmonary manifestations of this slowly progressive hematological condition. Conclusion. - Pulmonary manifestations of Waldenstrom's macroglobulinemia result in various clinical and radiological patterns. A serum protein electrophoresis should be performed in cases of pleuropulmonary opacities persisting despite antibiotics. (C) 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.