What is the presentation and progression of persistent polyclonal B-cell lymphocytosis? — Kathy Burge, CFNP, Bluefield, W. Va.

Persistent polyclonal B-cell lymphocytosis (PPBL) is a rare disease that is characterized by a stable, polyclonal CD19-positive and CD5-negative lymphocytosis. Middle-aged females who smoke represent the most common demographic group diagnosed with PPBL. 

Patients typically present with asthenia, myalgias, and splenomegaly. It is often mistaken for a low-grade lymphoma. The key to diagnosis is the presence of binucleated lymphocytes in the peripheral blood and a polyclonal increase in serum immunoglobulin M (IgM). 

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Although PPBL is generally a benign disorder, about 10% of patients will go on to develop a malignancy, most likely diffuse large B-cell lymphoma. — Claire O’Connell, MPH, PA-C (190-3)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.