IgM Monoclonal Gammopathy in Gastric MALToma

An 80-year-old male with a 3-year history of IgM kappa paraproteinemia and a presumed diagnosis of Waldenstrom's macroglobulinemia (WM) presented as a new patient to establish care. He had initially presented 3y ears ago with 6 months of intermittent fevers and chills occurring approximately twice monthly. Diagnostic work-up at that point had included positron emission tomography-computed tomography (PET-CT) and MRI, both of which were negative. No esophagogastroduodenoscopy (EGD) was performed as part of the work-up. Blood work revealed an IgM paraproteinemia of 492 mg/dl. He was further evaluated by hematology and rheumatologyphysicians who gavea diagnosis of WM for his paraproteinemia and familial Mediterranean fever (FMF) for his intermittent fevers and chills. The FMF was clinically diagnosed after demonstrating symptom resolutionwith a trial of colchicine. Gene testing was not performed. With the resolution of the fever and chills, management consisted of interval trending of the IgM paraproteinemia. Over a 3-year