Subacute hepatitis in Waldenström's macroglobulinemia

Abstract

A patient with primary macroglobulinemia, with characteristic organ manifestations, had subacute fatal hepatitis, apparently homologous serum jaundice. By fluorescence immunocytochemical technics, macroglobulins were demonstrated in plasma cells and in basophilic reticuloendothelial cells, the latter sometimes occurring as littoral cells of sinusoids of liver and spleen. Very few of these hepatic and splenic cells contained 7S gamma globulin (GG). The macroglobulin distribution in the liver corresponded to the distribution of 7S globulins in similar cases of subacute hepatitis in the absence of macroglobulinemia. This was interpreted to indicate that the macroglobulin-producing cells in the liver were reactive rather than neoplastic, immunologically competent cells. Casts in the distal convoluted renal tubules reacted with antibody to 19S macroglobulins but were probably cross reacting 2S globulins.