Fatal cerebral hemorrhage in a patient with CD19-positive Igm-producing aggressive plasma cell myeloma, hyperviscosity syndrome and cryoglobulinemia

Adnan Alatoom, Rania Elsabrouty, Jason Willis, Christie Boils, Ravindra Sarode, Ibrahim Hashim, Huan You Wang

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

IgM plasma cell myeloma (PCM) is a rare entity, and CD19 positivity is found in only 1-4% of PCM. Here we report a unique case of IgM PCM, in which the plasma cells are positive for CD19. Clinically, the patient presented with hyperviscosity syndrome, mimicking the clinical manifestation of Waldenstrom's macroglobulinemia. In addition, the IgM para-protein from the patient behaved like cryoglobulins, which interfered with some of the laboratory measurements and resulted in erroneous platelet count, mean platelet volume, and serum IgM level. Despite chemotherapy, the PCM persisted and progressed to plasma cell leukemia, and the patient died of a left frontal hematoma with widespread cerebral hemorrhage extending from left lateral ventricle, third ventricle, fourth ventricle, to cisterna magna. This case represents the first CD19+ IgM-producing PCM and the second case of brain hemorrhage due to plasma cell myeloma/leukemia.

Original languageEnglish (US)
Pages (from-to)498-507
Number of pages10
JournalInternational Journal of Clinical and Experimental Pathology
Volume2
Issue number5
StatePublished - 2009

Fingerprint

Cryoglobulinemia
Cerebral Hemorrhage
Multiple Myeloma
Immunoglobulin M
Plasma Cell Leukemia
Mean Platelet Volume
Cisterna Magna
Cryoglobulins
Fourth Ventricle
Waldenstrom Macroglobulinemia
Third Ventricle
Intracranial Hemorrhages
Lateral Ventricles
Plasma Cells
Platelet Count
Hematoma
Heart Ventricles
Drug Therapy
Serum
Proteins

Keywords

  • CD19
  • Cerebral hemorrhage
  • Cryoglobulinemia
  • Hyperviscosity syndrome
  • IgM plasma cell myeloma
  • Lymphoplasmacytic lymphoma
  • Plasma cell leukemia
  • Waldenstrom's macroglobulinemia

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

Cite this

Fatal cerebral hemorrhage in a patient with CD19-positive Igm-producing aggressive plasma cell myeloma, hyperviscosity syndrome and cryoglobulinemia. / Alatoom, Adnan; Elsabrouty, Rania; Willis, Jason; Boils, Christie; Sarode, Ravindra; Hashim, Ibrahim; Wang, Huan You.

In: International Journal of Clinical and Experimental Pathology, Vol. 2, No. 5, 2009, p. 498-507.

Research output: Contribution to journalArticle

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AU - Alatoom, Adnan

AU - Elsabrouty, Rania

AU - Willis, Jason

AU - Boils, Christie

AU - Sarode, Ravindra

AU - Hashim, Ibrahim

AU - Wang, Huan You

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AB - IgM plasma cell myeloma (PCM) is a rare entity, and CD19 positivity is found in only 1-4% of PCM. Here we report a unique case of IgM PCM, in which the plasma cells are positive for CD19. Clinically, the patient presented with hyperviscosity syndrome, mimicking the clinical manifestation of Waldenstrom's macroglobulinemia. In addition, the IgM para-protein from the patient behaved like cryoglobulins, which interfered with some of the laboratory measurements and resulted in erroneous platelet count, mean platelet volume, and serum IgM level. Despite chemotherapy, the PCM persisted and progressed to plasma cell leukemia, and the patient died of a left frontal hematoma with widespread cerebral hemorrhage extending from left lateral ventricle, third ventricle, fourth ventricle, to cisterna magna. This case represents the first CD19+ IgM-producing PCM and the second case of brain hemorrhage due to plasma cell myeloma/leukemia.

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