title: Waldenstrom macroglobulinemia presenting as isolated persistent epistaxis: a very rare presentation.
abstract: Nose bleed is the most common rhinological emergency. There are multiple risk factors for the development of epistaxis and it can affect any age group, but it is the elderly population with their associated morbidity who often require more intensive treatment and subsequent admission. Most cases of epistaxis occur in the Little's area, a location readily accessible and treatable by cautery or anterior nasal packing. However, posterior epistaxis often requires more aggressive measures including posterior nasal packing and endoscopic cauterization. After posterior nasal packing, the two most common therapies for intractable epistaxis are transantral ligation of the internal maxillary artery and percutaneous embolization of the distal internal maxillary artery. However, optimal management of intractable posterior epistaxis remains controversial. We hereby report fourth case of Waldenstrom Macroglobulinemia in English literature, which presented as isolated persistent epistaxis and was treated by therapeutic plasmapheresis.
authors.affiliation: Department of E.N.T., Himalayan Institute of Medical Sciences, (HIHT University), Jollygrant; Doiwala, Dehradun, 248 140 Uttarakhand India.
authors.forename: Vinish
authors.initials: V
authors.lastname: Agarwal
authors.affiliation: Department of E.N.T., Himalayan Institute of Medical Sciences, (HIHT University), Jollygrant; Doiwala, Dehradun, 248 140 Uttarakhand India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Varshney
authors.affiliation: Department of E.N.T., Himalayan Institute of Medical Sciences, (HIHT University), Jollygrant; Doiwala, Dehradun, 248 140 Uttarakhand India.
authors.forename: S S
authors.initials: SS
authors.lastname: Bist
authors.affiliation: Department of E.N.T., Himalayan Institute of Medical Sciences, (HIHT University), Jollygrant; Doiwala, Dehradun, 248 140 Uttarakhand India.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Bhagat
authors.affiliation: Department of E.N.T., Himalayan Institute of Medical Sciences, (HIHT University), Jollygrant; Doiwala, Dehradun, 248 140 Uttarakhand India.
authors.forename: Sarita
authors.initials: S
authors.lastname: Mishra
authors.affiliation: Department of Radiology, Himalayan Institute of Medical Sciences, (HIHT University), Jollygrant; Doiwala, Dehradun, 248 140 Uttarakhand India.
authors.forename: Mamta
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Department of Pathology, Himalayan Institute of Medical Sciences, (HIHT University), Jollygrant; Doiwala, Dehradun, 248 140 Uttarakhand India.
authors.forename: Geeta
authors.initials: G
authors.lastname: Negi
authors.affiliation: Department of E.N.T., Himalayan Institute of Medical Sciences, (HIHT University), Jollygrant; Doiwala, Dehradun, 248 140 Uttarakhand India.
authors.forename: Namita
authors.initials: N
authors.lastname: Kabdiwal
keywords: Embolization; Epistaxis; Little’s area; Plasmapheresis; Waldenstrom macroglobulinemia