Waldenstrom's Macroglobulinaemia Presenting as Demyelinating Polyradiculoneuropathy

Patients (particularly elderly) undergoing evaluation for peripheral neuropathy of unknown cause should be screened for the presence of a monoclonal protein (M protein). The association of a neuropathy and a paraproteinaemia such as Waldenstrom's Macroglobulinaemia (WM) is not uncommon with the former antedating the haematologic symptoms by several years. Response to treatment has varied from good to very poor. We describe a case of WM presenting as a subacute demyelinating peripheral neuropathy. There was prompt resolution of the neuropathy with intravenous immunoglobulin therapy. Subsequent treatment with cyclophosphamide and plasmapheresis resulted in complete clinical remission with no further neurological relapses.