Cutaneous amyloidosis as the first presentation of Waldenstrom macroglobulinemia

Background: waldenstrom macroglobulinemia is a lymphoplasmacytic lymphoma with elevated serum immunoglobulin m and multi-organ involvement. primary systemic amyloidosis usually develops due to immunoglobulin light chains depositions in different organs due to an underlying gammopathy. case presentation: our patient was an 86-year-old man with macroglossia, ecchymotic patches and bullous lesions associated with a skin laxity on the periorbital, palmar, and glans penis areas. skin biopsy confirmed dermal amyloid depositions. in serum immunofixation electrophoresis, prominent monoclonal immunoglobulin-m lambda light chains were detected associated with prominent lymphoplasmacytic infiltration in bone marrow biopsy which was diagnosed as waldenstrom macroglobulinemia. conclusion: skin involvement presenting as cutaneous amyloidosis could be the first manifestation of waldenstrom macroglobulinemia. we should think about an underlying gammopathy in an old patient with skin laxity and ecchymosis.