Macroglobulinemia and malabsorption

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Intestinal involvement in IgM monoclonal gammopathy is unusual. In Waldenstrom's original series,1 one patient had diarrhea. Malabsorption or steatorrhea or both have been reported in other patients with macroglobulinemia.2–7 In one patient, monoclonal macroglobulin has been identified in dilated lymphatics and in the lamina propria extracellularly with the use of the immunofluorescent technique.7 Clinical improvement has been reported following administration of corticosteroids. In this case considerable resolution of histologic abnormalities of the small bowel was documented following treatment with cyclophosphamide and prednisone.

Case report

A 58-year-old married woman was well until August 1969 when fatigue and weakness developed. Her local physician administered parenteral medication unknown to her for anemia. She experienced mild improvement, but within a few weeks fatigue and weakness recurred. In November 1969, following a flu-like illness characterized by rhinorrhea, sore throat, diarrhea, and fever, she became anorexic. This was accompanied by a sensation of epigastric fullness and increased abdominal girth. She was hospitalized at another institution and anemia was diagnosed. The results of an upper gastrointestinal examination, barium enema, intravenous pyelogram, and liver scan were reported to be normal. An oral cholecystogram did not visualize. A bone marrow examination was reported as normal. She lost 15 kg in weight during the first 3 weeks of hospitalization. A low-fat diet, prednisone, 30 mg daily, and thyroid USP, 3 gr/day, were prescribed. Her appetite improved and no further weight loss occurred. The hemoglobin level was in the normal range and she was discharged from the hospital. In the 3 . .



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