Yang X, Chong Z, Ma C, Wang G, Yan C. Anemia - an initial manifestation of Bing-Neel syndrome: A case report.
Medicine (Baltimore) 2022;
101:e31239. [PMID:
36401435 PMCID:
PMC9678614 DOI:
10.1097/md.0000000000031239]
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Abstract
RATIONALE
It is very likely that we will miss Bing-Neel syndrome (BNS) when its initial sign is anemia.Patient concerns: A 59-year-old woman presented with episodic loss of consciousness, anemia, and extremity muscle strength scores (5-) and extremity tendon reflexes (++).
DIAGNOSES
Magnetic Resonance Imaging (MRI) showed abnormal signal in the left hippocampus, left insula, and right occipital lobe. Quantitative serum immunoglobulins showed elevated immunoglobulinm (IgM) (60.6g/L). Bone marrow biopsy showed lymphoplasmacytic lymphoma (LPL) and tested positive for the MYD88 L265P mutation suggesting Waldenström macroglobulinemia (WM).
INTERVENTIONS
The patient underwent 3 plasma exchange treatments in the department of hematology followed by chemotherapy (cyclophosphamide for injection, bortezomib for injection).
OUTCOMES
The patient's condition improved after treatment.
LESSONS
Clinicians must remain vigilant, as BNS may be the only sign of WM progression in a patient well-controlled on treatment.
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