Digital gangrene: A rare harbinger of Waldenström’s macroglobulinemia

Abstract

Waldenström’s Macroglobulinemia (WM) is a rare lymphoma characterized by monoclonal Immunoglobulin M (IgM) production and can remain asymptomatic for extended periods. Cryoglobulinemia is a known manifestation of WM, but cryoglobulinemic vasculitis causing digital gangrene as the initial presentation is exceedingly rare. We describe the case of a 40-year-old female who presented with cryoglobulinemic vasculitis-induced dry gangrene of her toes and fingers ten months before the diagnosis of WM. Digital gangrene in the absence of other clinical features pertaining to WM is unusual and should prompt consideration of underlying lymphoproliferative disorders. This case emphasizes the importance of considering underlying B-cell malignancies in the differential diagnosis of digital gangrene and the possibility that cutaneous manifestations may precede other disease manifestations by months or years.