Waldenström's macroglobulinemia: Report of a case with pulmonary involvement and improvement in pulmonary symptoms only following chlorambucil therapy

A case of Waldenström's macroglobulinemia is presented in which the sole demonstrable presenting clinical manifestation was related to pulmonary infiltration. Bone marrow aspirates revealed no increase in lymphocytic cells. Protein studies demonstrated the characteristic monoclonal increase in immunoglobulin M (IgM) which, by analytical ultracentrifugation, proved to be a 19S macroglobulin. A bronchial biopsy specimen, obtained at bronchoscopy, revealed a dense lymphocytic infiltration. There was an excellent clinical response to small (4 to 6 mg/day) doses of chlorambucil as evidenced by disappearance of symptoms, resolution of pulmonary lesions as seen on roentgenogram and decrease in abnormal serum protein.