Relapsed Waldenström macroglobulinemia presenting as bilateral parotid gland enlargement with multiple cystic lesions
Hsin-Yao Hung, Yu-Cheng Chang, Tsung-Yu YenRationale:
Waldenström macroglobulinemia (WM) is a rare lymphoplasmacytic malignancy, and extramedullary disease involving the parotid glands is an exceptionally uncommon presentation.
Patient concerns:
We report the case of a 79-year-old man with a history of WM who had achieved stable disease for several years following multiple courses of chemotherapy. He subsequently presented with bilateral parotid gland enlargement suspicious for relapsed WM.
Diagnoses:
Imaging studies revealed multiple cystic lesions, and relapsed WM was considered the most likely diagnosis based on markedly elevated serum immunoglobulin M (IgM) levels and polymerase chain reaction analysis of fine-needle aspirates demonstrating immunoglobulin heavy chain (IgH) gene rearrangement.
Interventions:
Given his poor clinical condition, the patient received palliative care.
Outcomes:
The patient died due to sepsis 4 months after the presentation of parotid enlargement.
Lessons:
This case highlights the importance of considering relapsed WM in the differential diagnosis of parotid gland enlargement, particularly in patients with a prior history of lymphoplasmacytic malignancy.