Peripheral retinopathy associated with Waldenström’s macroglobulinaemia

Bone marrow biopsy, performed in order to investigate recurrent spontaneous epistaxis associated with severe anaemia (haemoglobin 82g/dL) and serum cryoglobulinaemia, led to a diagnosis of low-grade lymphoplasmacytoid non-Hodgkin's lymphoma consistent with Waldenström's macroglobulinaemia. Serum hyperviscosity associated with aberrant monoclonal IgM levels underlies most ophthalmic manifestations in Waldenström's macroglobulinaemia. 1-3 Retinal findings show variable severity ranging from peripheral haemorrhages to symptomatic central involvement with macular oedema, cotton wool spots and optic disc swelling. 1-3 Pathology is usually independent of IgM specificity; nevertheless, paraneoplastic retinopathy associated with retinal antigen recognition has been reported. 4 The extent of retinal involvement varies according to IgM levels and the proportional increase in serum viscosity, and can be reversed following successful plasmapheresis. 5 Retinal findings remained unchanged in our patient despite satisfactory response to chemotherapy.