An unusual case of lymphoplasmacytic lymphoma/Waldenström macroglobulinemia presenting with intractable seizures and interference with automated testing

Lymphoplasmacytic lymphoma (LPL) is a B cell neoplasm composed of small lymphocytes, plasmacytoid and plasma cells, which typically involves the bone marrow. Most cases LPL present with Waldenstrom macroglobulinemia (WM) defined as presence monoclonal immunoglobulins IgM type in Herein, we case LPL/WM presenting intractable refractory seizures. A 71-year-old man 5-month history seizures was brought to emergency room after being found unresponsive. Automated hematology analysis revealed imprecise counts, wide variation, multiple error flags. Peripheral smear review showed extracellular pale blue clumps amorphous material. marked cryoprecipitate 7% detected on cryoglobulin screen. Serum protein electrophoresis (SPEP) M-protein (1.58 g/dL) gamma region. immunofixation an lambda protein. marrow biopsy hypercellularity increased lymphocytes forming interstitial aggregates, admixed cells. Immunohistochemically, cells were positive for CD20 negative CD3, CD5, CD10, CD23, Cyclin D1 (Bcl-1), Bcl-6. CD138 highlighted Flow cytometric 2.7% predominance light chains, suggestive population. MYD88 mutational c.794T>C(p.L265P) mutation. diagnosis lymphoplasmacytic lymphoma/Waldenstrom established. The patient underwent plasmapheresis leading significant improvement his symptoms. This highlights rare, unusual presentation where interference automated testing led identification cryoglobulinemia subsequent LPL/WM.