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Old 10-01-2011
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Urine Sample Urinary Bence Jones proteins were positive

M.C., a 62 year old male developed anorexia and general debility 6 months before admission. One week before admission, he developed a purpuric rash over both the lower limbs and buttocks.
On examination, he was found to be of medium build and poorly nourished. There was mild pallor and purpura over both the lower limbs and buttocks and a few purpuric spots on the trunk. The upper limbs and the face were unaffected. He had hepatosplenomegaly. Laboratory investigations revealed haemoglobin of 9.7 gm%. Haematocrit was 29%, MCHC 34%, Retic count 1.9%, WBC 14,900/cmm; with neutrophils 85% and lymphocytes 15%; Platelet count was normal. There were no abnormal cells. Urine examination showed mild albuminuria (5-6 RBC/high power field). Urinary Bence Jones proteins were positive. The blood urea nitrogen was 48 mg% with a serum creatinine of 3.5 mg%. Liver function tests were within normal limits. An X-ray of the chest revealed enlarged paratracheal lymph nodes. A radionucleide bone scan was normal. Bone marrow aspiration biopsy was normal. A bone marrow trephine biopsy showed 5% plasma cells. Total serum proteins were 10.6 gm% and electrophoresis showed IgM to be elevated to 3.5 g m%. What is the most likely diagnosis?

A) Monoclonal gammopathy of undetermined significance
B) Multiple myeloma
C) Waldenström macroglobulinemia
D) Plasmacytoma
E) Non-hodgkin lymphoma
F) Chronic lymphoblastic leukemia
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Old 10-01-2011
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C) Waldenström macroglobulinemia

Because BJ proteins in urine and no lytic bone lesions,anemia,involvement of liver and spleen.
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Old 10-01-2011
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answer is c
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Old 10-02-2011
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C) Waldenström macroglobulinemia
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Old 10-02-2011
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C) Waldenström macroglobulinemia

the clue for dx is IgM in electrophersis and old age
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