WALDENSTROMS MACROGLOBULINEMIA SECRETING A PARAPROTEIN WITH LUPUS ANTICOAGULANT ACTIVITY - POSSIBLE ASSOCIATION WITH GASTROINTESTINAL-TRACTDISEASE AND MALABSORPTION

A 51 year old man with Waldenstrom's macroglobulinaemia presented with a malabsorptive syndrome related to extensive small bowel lymphangiec tasia caused by immunoglobulin accumulation. The patient's plasma had strong lupus anticoagulant activity and the IgM lambda paraprotein dis played specificity for the negatively charged phospholipids phosphatid yl serine and phosphatidyl inisitol, as well as the neutral phosphatid ic acid. Despite treatment for the macroglobulinaemia the patient died and at necropsy was found to have myocardial ischaemia and segmental infarcts in the spleen and kidney. The coexistence of these relatively rare findings suggests a possible association between Waldenstrom's m acroglobulinaemia with gastrointestinal manifestations and paraprotein specificity for phospholipid.