Abstract

Hyperviscosity   syndrome   (HVS)   is   a   life-threatening   complication.   The   clinical   manifestations include a variety of symptoms like visual symptoms, altered mental status, stroke  or  congestive  heart  failure.  Prompt  treatment  is  needed  to  avoid  progression  to  multisystem organ failure. We report a case of a 73-year-old man with a 3-months history of headaches and altered mental status. His neurological exam showed symmetrical decreased pain, thermal and tactile sensitivity in the upper and lower limbs and symmetrical decreased muscle strength in the lower limbs. His eye exam showed retinal hemorrhages and dilated retinal veins. His blood counts showed anemia, increased C-reactive protein, sedimentation rate and serum viscosity. He had an elevated immunoglobulin M and serum immunofixation revealed  Ig  M-kappa  paraprotein.  The  bone  marrow  aspiration  and  biopsy  revealed  a  Waldenström  Macroglobulinemia.  He  was  diagnosed  with  HVS  and  was  treated  with  plasmapheresis, chemotherapy and fluids.HVS diagnosisrequires a high degree of clinical suspicion, andclinicians should be aware of suggestive clinical and laboratory findings.

Keywords

waldenström’s macroglobulinemia, hyperviscosity syndrome, plasmapheresis, paraproteinaemia, oncologic emergencies, herbal products, alcohol, tobacco, illicit drugs