Lymphoplasmacytic Lymphoma Manifesting as a Cervical Spine Mass with Parkinson-Like Symptoms Treated with Ibrutinib

Abstract Waldenstrӧm Macroglobulinemia (WM) is a rare B-cell malignancy characterized by lymphoplasmacytic lymphoma (LPL) involvement of the bone marrow with an IgM monoclonal gammopathy. We present a case of Parkinson-like symptoms, in which diagnostic workup including imaging, biopsy, and lumbar puncture revealed both an LPL manifesting as a cervical spine mass and central nervous system involvement of LPL (termed Bing Neel syndrome) as the etiologies of the patient's presenting symptoms. Ibrutinib was administered, at a lower dose of 280mg, due to the patient's history of arrhythmias, in combination with radiation to the cervical spine mass and steroids. Four weeks later, the patient's symptoms had completely resolved. This case highlights a rare presentation of LPL as well as the efficacy of ibrutinib.