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Vol. 14. Issue 6.
Pages 869-874 (November - December 2008)
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Vol. 14. Issue 6.
Pages 869-874 (November - December 2008)
Caso Clínico/Case Report
Open Access
Não fosse no pé o calcanhar de Aquiles – A propósito de um caso clínico
Shouldn't the Achilles' Heel be on the foot – Regarding a clinical case
Visits
5803
Raquel Cavaco
,****
Corresponding author
raquelcavacopt@yahoo.com

Correspondência / Correspondence to: Raquel Avelãs Nunes Silvestre Cavaco, Rua de Arroteias Lote 1 A 9, 1685 – 058 Caneças, TM: 969410552
, Célia Machado**, J. Gorjão Clara***
* Interna do Internato Complementar de Medicina Interna, Serviço de Medicina Interna II do Hospital de Pulido Valente
** Assistente Graduada de Medicina Interna, Serviço de Medicina Interna II do Hospital de Pulido Valente
*** Director do Serviço de Medicina Interna II, Serviço de Medicina Interna II do Hospital de Pulido Valente
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Article information
Resumo

A suspeição está na base de uma investigação clínica completa, sendo de extrema importância a revisão dos casos clínicos nos quais não consigamos estabelecer um diagnóstico definitivo. Desta revisão surgem hipóteses diagnósticas que contemplam doenças raras, como a macroglobulinemia de Waldenstrom, doença linfoproliferativa de células tipo B, caracterizada por infiltração medular e produção de IgM monoclonal. Em 1% destas gamapatias são diagnosticadas formas biclonais. Apresentamos o caso clínico de um doente com 74 anos, internado em Outubro/04 por colecistite aguda, tendo os exames pré-operatórios revelado derrame pleural bilateral. Durante o internamento foi feita minuciosa investigação etiológica, que foi contudo inconclusiva. Em Maio/05 foi internado, tendo sido submetido a talcagem pleural direita e a investigação clínica, também esta inconclusiva. Em Julho/05 foi reinternado num serviço de medicina interna, por anasarca e dor nos pés. Fez-se nova investigação e o diagnóstico final foi de macroglobulinemia de Waldenstrom.

Rev Port Pneumol 2008; XIV (6): 869-874

Palavras-chave:
Macroglobulinemia de Waldenstrom
hematooncológico
hiperviscosidade
electroforese de proteínas séricas
imunosserologia
infiltração medular
critérios diagnósticos
Abstract

Clinical suspicion is the bedrock of a thorough clinical work-up, and a review of the clinical files with no definitive diagnosis is a must. Such a review can uncover rare diagnoses, such as Waldenstrom's macroglobulinaemia, a proliferative B-cell disease characterised by medular infiltration and monoclonocal IgM production. 1% of these are biclonal. We present a case of a 74 year old patient diagnosed in October 2004 with acute cholecystitis. Surgical evaluation revealed bilateral pleural effusion with an inconclusive aetiology. Patient underwent a right pleurodesis in May 2005 and the aetiology remained inconclusive. The third evaluation, in July 2005, led to a final diagnosis of Waldenstrom's macroglobulinaemia.

Rev Port Pneumol 2008; XIV (6): 869-874

Key-words:
Waldenstrom’s macroglobulinemia
hemato-oncology
hyperviscosity
protein electrophoresis
immune serology
medullar infiltration
diagnostic criteria’s
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Bibliografia
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Nervous system lymphoid infiltration in Waldenstrom macroglobulinemia. A case report.
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Autoimmunity in Waldenstrom’s macroglobulinaemia.
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Diagnosis and management of Waldenstrom’s macroglobulinemia.
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Clin Cancer Res, 13 (2007), pp. 2005-2013
Copyright © 2008. Sociedade Portuguesa de Pneumologia/SPP
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