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Int J Clin Exp Pathol 2(5),498-507;2009

Case Report
Fatal Cerebral Hemorrhage in a Patient with CD19-positive IgM-producing Aggressive
Plasma Cell Myeloma, Hyperviscosity Syndrome and Cryoglobulinemia

Adnan Alatoom, Rania Elsabrouty, Jason Willis, Christie Boils, Ravindra Sarode, Ibrahim Hashim and Huan-You Wang

Department of Pathology, the University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, Texas 75390

Received 20 January 2009; Accepted 06 February 2009; Available online 09 February 2009

Abstract: IgM plasma cell myeloma (PCM) is a rare entity, and CD19 positivity is found in only 1-4% of PCM. Here we report a unique case of
IgM PCM, in which the plasma cells are positive for CD19. Clinically, the patient presented with hyperviscosity syndrome, mimicking the clinical
manifestation of Waldenstrom’s macroglobulinemia. In addition, the IgM para-protein from the patient behaved like cryoglobulins, which
interfered with some of the laboratory measurements and resulted in erroneous platelet count, mean platelet volume, and serum IgM level.
Despite chemotherapy, the PCM persisted and progressed to plasma cell leukemia, and the patient died of a left frontal hematoma with
widespread cerebral hemorrhage extending from left lateral ventricle, third ventricle, fourth ventricle, to cisterna magna. This case represents
the first CD19+ IgM-producing PCM and the second case of brain hemorrhage due to plasma cell myeloma/leukemia. (IJCEP901003).

Key Words: IgM plasma cell myeloma, plasma cell leukemia, CD19, Waldenstrom’s macroglobulinemia, lymphoplasmacytic lymphoma,
hyperviscosity syndrome, cryoglobulinemia, cerebral hemorrhage

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Address all correspondence to: Huan-You Wang, M.D., Ph.D., Department of Pathology, UT Southwestern Medical Center at Dallas, 5323
Harry Hines Boulevard, Dallas, TX 75390-9073. Tel: 214-648-6820; Fax: 214-590-6667; Email:
huan-you.wang@utsouthwestern.edu