Waldenström's macroglobulinaemia presenting as isolated epistaxis: a common complaint but a rare cause

Summary A patient with isolated severe epistaxis and non-specific history or examination findings was shown to have anaemia, raised erythrocyte sedimentation rate (ESR), renal impairment and raised total protein with hypercoagulable blood. Waldenstrom's macroglobulinaemia was diagnosed after serum electrophoresis and bone marrow studies. Urgent plasma exchange and chemotherapy were undertaken to good effect. This case was a diagnostic dilemma, as the presentation of this common complaint did not initially suggest the rare underlying cause.