Waldenstrom Macroglobulinemia Leading to Cholestatic Liver Injury and Rapid Progression to Liver Failure

Waldenstrom macroglobulinemia (WM) is an indolent B-cell neoplasm with generally good prognosis, and while hepatic involvement in WM has been documented in the literature, it is rarely clinically significant. We present a case of a 77-year-old man with WM who presented with a cholestatic liver injury and rapid progression to decompensated liver disease. The patient ultimately transitioned to comfort care and died from liver failure. This case not only highlights the rarity of this poor outcome from WM, but also underscores the importance of early recognition of infiltrative malignancy as a potential cause of liver failure.