A CURIOUS CASE OF FIBROSING PLEURITIS LINKED TO WALDENSTRÖM

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Fibrosing pleuritis is a condition not widely reported or well understood, and thought to develop in response recurrent pleural inflammation associated with exudative effusions. In Waldenström's macroglobulinemia (WM), patients extramedullary pulmonary involvement are sparingly mentioned as cause fibrosing literature. We discuss rare presentation patient macroglobulinemia-associated CASE PRESENTATION: An 88 year old male presented shortness breath CTA chest showing moderate right-sided effusion, para-aortic lymphadenopathy T-5 vertebral body lucencies. A diagnostic thoracentesis revealed an fluid elevated protein 5.1 g/dL negative cytology. Serum electrophoresis showed M spike 1.2 g/dL, immunofixation monoclonal IgM lambda, quantitative was at 2079 mg/dL bone marrow biopsy metastatic prostate adenocarcinoma lymphoplasmacytic lymphoma (LPL). month later, he similar complaints findings effusions necessitating VATS, decortication pleurodesis. The pleuritis, genetic analysis positivity for MYD88 gene mutation, suggestive macroglobulinemia. DISCUSSION: cancer characterized by infiltration IgM-secreting cells, it most common type LPL. Apart from involvement, there few reports presentations ranging lung nodules, diffuse infiltrates Attempting establish malignant etiology effusion WM can be challenging, standard techniques may insensitive. Diagnosis made identifying greater than 10 % clonal cells marrow, L265P mutation found positive 93-97% patients. PCR detection this had 100% sensitivity 92.1% specificity based on one study. Treatment decisions symptoms, prospective studies demonstrating durable Ibrutinib monotherapy; greatest effect seen mutation. Our treated successfully Ibrutinib. CONCLUSIONS: Malignant resultant manifestation macroglobulinemia.Greater 90 these have mutations, growing evidence that testing point towards diagnosis absence cytology WM, aid prompt treatment. REFERENCE #1: Huggins JT, Sahn SA. Causes management fibrosis. Respirology. 2004 Nov;9(4):441-7. doi: 10.1111/j.1440-1843.2004.00630.x. PMID: 15612954 #2: Barnes M, Sharma P, Kumar V, Kaell A, LiPera W. Pleural supporting decision treat Waldenstrom's macroglobulinemia: case report. J Med Rep. 2020 Jul 13;14(1):98. 10.1186/s13256-020-02404-x. 32654665; PMCID: PMC7358196. #3: Banwait R, Aljawai Y, Cappuccio J, McDiarmid S, Morgan EA, Leblebjian H, Roccaro AM, Laubach Castillo JJ, Paba-Prada C, Treon Redd Weller E, Ghobrial IM. Extramedullary Waldenström Am Hematol. 2015 Feb;90(2):100-4. 10.1002/ajh.23880. Epub 2014 Nov 19. 25349134 DISCLOSURES: No relevant relationships Muneer Al Zoby, source=Web Response Omotooke Babalola, Timothy Barreiro, Rishanki Jha, Oyidiya Osoka, Jeannie Ur,