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Manifestations of macroglobulinemic lymphoma include lymphadenopathy, splenomegaly and bone marrow involvement. Renal presentations are unusual and complications of renal function are even less frequent. A review of all patients diagnosed with Waldenström macroglobulinemia at our institution from January 1987 to December 1993, revealed 4 cases (6%) with renal presentations.

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A case of pulmonary nocardiosis with empyema in a 55-year-old man with macroglobulinemic lymphoma is presented. Treatment with imipenem followed by oral trimethoprim-sulfamethoxazole (TMP-SMX) resolved his symptoms and cleared the roentgenographic abnormalities. This case illustrates the clinical potential of imipenem against Nocardia.

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Renal transplantation in Waldenström's macroglobulinaemia.

Nephrol Dial Transplant

November 1988

Department of Renal Medicine, Addenbrooke's Hospital, Cambridge.

A 60-year-old man presented with hypertension, proteinuria and renal failure. He had an IgM lambda plasma and urinary paraprotein, but bone-marrow examination and skeletal survey were normal, and renal biopsy was felt to be consistent with chronic pyelonephritis. Renal failure progressed, and haemodialysis and later cadaveric renal transplantation were performed.

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The case of a patient with elevated carboxyhemoglobin saturation, prolonged carboxyhemoglobin half-life, and Waldenström's macroglobulinemia is presented. In vitro studies on the patient's blood showed that the half-life of carboxyhemoglobin in the macroglobulinemic blood was about three times longer than in a normal blood sample. Similar experiments using normal and macroglobulinemic blood samples were done in which the macroglobulinemic plasma was replaced by normal saline, and there was no difference in the half-lives.

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