An asymptomatic non-diabetic 69-year-old man with no medical history was referred for incidental bilateral retinal haemorrhages. Visual acuities were 20/20 in both eyes. Anterior segment examination was unremarkable. Funduscopy revealed normal optic discs and maculae and bilateral peripheral blot haemorrhages and microaneurysms (figure 1A,B). Wide-field fluorescein angiography showed peripheral retinal vessel wall staining with capillary non-perfusion and scattered microaneurysms (figure 1C,D). Blood pressure was normal. Bone marrow biopsy, performed in order to investigate recurrent spontaneous epistaxis associated with severe anaemia (haemoglobin 82 g/dL) and serum cryoglobulinaemia, led to a diagnosis of low-grade lymphoplasmacytoid non-Hodgkin's lymphoma consistent with Waldenström's macroglobulinaemia. Baseline IgM concentration was 34 g/L and further decreased to 16 g/L after 3 months of treatment with fludarabine and cyclophosphamide.
This case highlights the importance of considering haematological disorders in the differential diagnosis of peripheral retinal haemorrhages, a rather common clinical finding usually associated with diabetes mellitus or hypertension. Serum hyperviscosity...
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