Invasive Cutaneous Candidiasis, Autoimmune Hemolytic Anemia and Pancytopenia: A Challenging Scenario for Waldenström Macroglobulinemia in an Elderly Patient

Author:

Caballero Juan Carlos1ORCID,Askari Elham1,Carrasco Nerea2,Piris Miguel Angel3ORCID,Perez de Camino Begoña1,Pardo Laura1,Cornago Javier1ORCID,Lopez-Lorenzo Jose Luis1ORCID,Llamas Pilar1,Solan Laura1ORCID

Affiliation:

1. Hematology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain

2. Infectious Diseases Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain

3. Pathology Department, Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain

Abstract

Waldenström macroglobulinemia (WM) is a slowly progressive hematologic malignancy that usually responds rapidly to treatment. Being a lymphoplasmacytoid neoplasm, it is associated with a monoclonal IgM component, which may be associated with multiple manifestations and symptoms. We report the case of a 77-year-old woman diagnosed with WM following the development of severe and sudden pancytopenia associated with a cold agglutinin syndrome. In order to treat the WM and the underlying hemolysis, treatment with rituximab, corticosteroids and cyclophosphamide was started. Despite the improvement in hemolysis parameters, pancytopenia persisted, and we started a second line with ibrutinib. During treatment the patient developed an uncommon invasive fungal infection (IFI) with bone marrow granulomatosis and myelofibrosis. This case shows an unusual clinical course with a poor hematopoietic response to treatment and a large number of intercurrent complications.

Publisher

MDPI AG

Subject

General Biochemistry, Genetics and Molecular Biology,Medicine (miscellaneous)

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