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Neurological picture
Paravertebral Waldenström's macroglobulinaemia presenting as pseudoclaudication
  1. S W Taylor1,
  2. M Q Lacy2,
  3. D F Black3,
  4. C J Klein1
  1. 1Peripheral Nerve Research Laboratory, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Medicine (Hematology), Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to C J Klein, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; klein.christopher{at}mayo.edu

http://dx.doi.org/10.1136/jnnp.2010.218313

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    A 60-year-old man presented with a 1-year history of progressive, radiating back and leg pain worsened by standing consistent with pseudoclaudication. Neurological examination and electrodiagnostic studies were normal. MRI showed enhancement of the paravertebral soft tissues adjacent to the L5-S1 vertebrae with neuroforaminal involvement (figure 1A). An IgM monoclonal protein was detected in serum and bone marrow biopsy demonstrated plasmacytoid lymphocytes. Image guided biopsy of the abnormal L5 paravertebral tissue confirmed lymphoplasmacytic lymphoma/Waldenström's macroglobulinaemia (WM) (figure 1E–G). Rituximab therapy and lumbosacral radiation were instituted resulting in reduction of the size of the monoclonal protein and soft tissue mass, and improvement of pain. One year later the patient developed recurrent pain. Repeat MRI showed …

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    Footnotes

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.