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Case Reports
. 2023 Mar 24;11(4):1007.
doi: 10.3390/biomedicines11041007.

Invasive Cutaneous Candidiasis, Autoimmune Hemolytic Anemia and Pancytopenia: A Challenging Scenario for Waldenström Macroglobulinemia in an Elderly Patient

Juan Carlos Caballero  1 , Elham Askari  1 , Nerea Carrasco  2 , Miguel Angel Piris  3 , Begoña Perez de Camino  1 , Laura Pardo  1 , Javier Cornago  1 , Jose Luis Lopez-Lorenzo  1 , Pilar Llamas  1 , Laura Solan  1
Affiliations
Case Reports

Invasive Cutaneous Candidiasis, Autoimmune Hemolytic Anemia and Pancytopenia: A Challenging Scenario for Waldenström Macroglobulinemia in an Elderly Patient

Juan Carlos Caballero et al. Biomedicines. .

Abstract

Waldenström macroglobulinemia (WM) is a slowly progressive hematologic malignancy that usually responds rapidly to treatment. Being a lymphoplasmacytoid neoplasm, it is associated with a monoclonal IgM component, which may be associated with multiple manifestations and symptoms. We report the case of a 77-year-old woman diagnosed with WM following the development of severe and sudden pancytopenia associated with a cold agglutinin syndrome. In order to treat the WM and the underlying hemolysis, treatment with rituximab, corticosteroids and cyclophosphamide was started. Despite the improvement in hemolysis parameters, pancytopenia persisted, and we started a second line with ibrutinib. During treatment the patient developed an uncommon invasive fungal infection (IFI) with bone marrow granulomatosis and myelofibrosis. This case shows an unusual clinical course with a poor hematopoietic response to treatment and a large number of intercurrent complications.

Keywords: Waldenström macroglobulinemia; case report; granulomatosis; invasive candidiasis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Exudative necrohemorrhagic lesions located in the lower third of the left leg. Patchy involvement can be observed on healthy skin with a tendency to violaceous coloration. (B) Evolution of cellulitis lesions in left leg after systemic treatment with caspofungin. Disappearance of necrohemorrhagic lesions and improvement in color and appearance of the surrounding skin can be observed.
Figure 2
Figure 2
Magnetic resonance imaging of legs in axial (left) and sagittal (right) views. Arrows show the deep involvement of the infection with hyperintense image.
Figure 3
Figure 3
Circled, pseudohyphae observed in skin sample of the lesions on the left leg. PAS staining (60×).
Figure 4
Figure 4
Histology of bone marrow. Circled granulomas are shown in different stains: hematoxylin–eosin (20×) (A,B) and CD11c (10×) (C). Reticulin staining showing grade 2 bone marrow fibrosis (10×) (D).
See this image and copyright information in PMC

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