Coexisting Waldenström macroglobulinaemia and alveolar echinococcosis presenting with chylothorax that resolved on treatment: a diagnostic and therapeutic challenge

Authors

• François Perramond Department of Internal Medicine, Hôpital de Saint-Imier, Saint-Imier, Switzerland
• Serge Bugnon Department of Internal Medicine, Hôpital de Saint-Imier, Saint-Imier, Switzerland
• Jérôme Voegeli Department of Haematology, Centre Médico-Chirurgical Volta, La Chaux-de-Fonds, Switzerland
• Annalisa Berzigotti Department of Hepatology, Inselspital, Hôpital Universitaire de Berne, Berne, Switzerland 0000-0003-4562-9016

francois.perramond@outlook.com

Keywords

Abstract

Introduction: Waldenström macroglobulinaemia is a lymphoplasmacytic lymphoma producing monoclonal immunoglobulin M (IgM), and both the disease and its treatment can cause immunosuppression. Alveolar echinococcosis is a parasitic infection that primarily involves the liver but may present with extrahepatic manifestations.
Case description: We report the case of a patient who presented with chylothorax and non-specific hepatic lesions and was then diagnosed with Waldenström macroglobulinaemia. In addition to this diagnosis, alveolar echinococcosis was subsequently confirmed by liver biopsy and serology.
Discussion: Diagnostic interpretation was challenging, as these features may occur in both conditions. A multidisciplinary approach was needed to establish the treatment plan due to overlapping symptomatology and the risk of treatment-related immunosuppression.
Conclusion: This case highlights the importance of considering a broad differential diagnosis for a chylothorax and hepatic lesions in an oncological context and illustrates the therapeutic challenges of managing an indolent haematologic malignancy in the context of a chronic parasitic infection.

References