Waldenström macroglobulinemia; a rare disease causing ulcers

Mr. J 64 y old developed in 2007 leg swelling with dark oozing patches.Blood tests normal.Bone marrow biopsy shows no evidence of myeloma with no diagnostic abnormalities.Histology of the affected skin showed deposits of paraprotein in the small vessels causing luminal obstruction which is the cause of ischemic skin lesions and ulcer formation.The disease is called Waldenström macroglobulinemia.Mr.J followed multiple prescriptions and applied different dressings; Mebo, hydrocolloid, fucidine.The number of ulcers was reduced to one unable to heal because of infection,excessive amount of corticosteroids as treatment of arthritis and WM.Flamazine used for 15days;infection disappear,ulcer shrunk but not able to completely heal.Ulcer healed after three weeks of the use of collagen dressing.Pain on the wound and the surroundings was permanent like throbbing.Protection of the area was very important to avoid any blister appearance;the skin was fragile,thin and able to crack very easy.He was very happy to see the results after giving up hope he considered his leg ulcer healing as miraculous.This case was followed at home because I am a relative so I had full time to answer patient’s questions and his family,also to let them participate actively in wound care.They admit that without my guidance they were unable to achieve all this by themselves.They were following the doctor’s prescription as he taught them to do but they needed to be taught more about many other things to achieve complete healing.They considered education very important in preventing and in treating.My contacts with the physician through emails showing the leg ulcer pictures were much appreciated as he was following the case of his patient in a caring way.We considered sometimes that our patient’s education had a positive outcome when we receive a positive feedback,but it seems that there is always some gap and the need to direct the patient is always present.