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                        "numero" => "3&#8211;4"
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                          "autores" => array:1 [
                            0 => "S&#46; Weinstein"
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                        "paginaFinal" => "1712"
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                        "volumen" => "13"
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                        "paginaFinal" => "2013"
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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)
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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
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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
** Assistente Graduada de Medicina Interna
*** Director do Serviço de Medicina Interna II
**** Serviço de Medicina Interna II do Hospital de Pulido Valente
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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 pleu-ral 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.

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.

Key-words:
Waldenstrom's macroglobulinemia
hemato-oncology
hyperviscosity
protein electrophoresis
immune serology
medullar infiltration
diagnostic criteria's
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Bibliografia
[1.]
J. Moura e Sá.
Derrame pleural recidivante com macroglobulinemia – caso clínico com revisão da literatura.
Rev Port Pneumol, X (2004), pp. 165-171
[2.]
G.A. Pangalis, et al.
Differential diagnosis of Waldentrom's macroglobulinemia and other B-cell disorders.
Clin Lymphoma, 5 (2005), pp. 235-240
[3.]
N. Singhal, et al.
Waldentrom¿s macroglobulinemia.
J Assoc Physicians India, 52 (2004), pp. 981-985
[4.]
M. Bjorkholm, et al.
Patterns of clinical presentation, treatment, and outcome in patients with Waldenstrom's macroglobulinemia: a two-case institution study.
Semin Oncol, 30 (2003), pp. 226-230
[5.]
F. Reichenberger, et al.
Pulmonary infiltrate, pleural effusion and IgM macroglobulinaemia.
Pneumologie, 58 (2004), pp. 33-35
[6.]
T. Levine, et al.
Peripheral neuropathies in Waldenstrom's macroglobulinemia.
J Neurol Neurosurg Psychiatry, 77 (2006), pp. 224-228
[7.]
J. Drappatz, T. Batchelor.
Neurologic complications of plasma disorders.
Clin Lymphoma, 5 (2004), pp. 163-171
[8.]
S. Massengo, et al.
Nervous system lymphoid infiltration in Waldenstrom macroglobulinemia. A case report.
J Neurooncol, 62 (2003), pp. 353-358
[9.]
V. Jonsson, et al.
Autoimmunity in Waldenstrom's macroglobulinaemia.
Leuk Lymphoma, 34 (1999), pp. 373-379
[10.]
M.A. Dimopoulos, et al.
Diagnosis and management of Waldenstrom's macroglobulinemia.
J Clin Oncol, 23 (2005), pp. 1564-1577
[11.]
S. Weinstein, et al.
Biclonal IgA and IgM gammopathy in lymphocytic lymphoma.
Clin Chem, 30 (1984), pp. 1710-1712
[12.]
R. Schultz, et al.
Molecular analysis in a patient with Waldentrom's macroglobulinemia reveals a rare case of biclonality.
Clin Cancer Res, 13 (2007), pp. 2005-2013
Copyright © 2008. Sociedade Portuguesa de Pneumologia
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