RESUMO
We report a rare case of multiple myeloma with biclonal gammopathy (IgG kappa and IgA lambda type) in a 58-year-old man with prostate cancer who presented with lower back pain. Through computed tomography (CT) imaging, an osteolytic lesion at the L3 vertebra and an enhancing lesion of the prostate gland with multiple lymphadenopathies were found. In the whole body positron emission tomography-computed tomography (PET-CT), an additional osteoblastic bone lesion was found in the left ischial bone. A prostate biopsy was performed, and adenocarcinoma was confirmed. Decompression surgery of the L3 vertebra was conducted, and the pathologic result indicated that the lesion was a plasma cell neoplasm. Immunofixation electrophoresis showed the presence of biclonal gammopathy (IgG kappa and IgA lambda). Bone marrow plasma cells (CD138 positive cells) comprised 7.2% of nucleated cells and showed kappa positivity. We started radiation therapy for the L3 vertebra lesion, with a total dose of 3,940 cGy, and androgen deprivation therapy as treatment for the prostate cancer.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma/complicações , Antineoplásicos/uso terapêutico , Células da Medula Óssea/metabolismo , Terapia Combinada , Imunoeletroforese , Cadeias kappa de Imunoglobulina/sangue , Cadeias lambda de Imunoglobulina/sangue , Mieloma Múltiplo/complicações , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Neoplasias da Próstata/complicações , Coluna Vertebral/patologia , Sindecana-1/metabolismo , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Korea is an endemic area of scrub typhus and it is a common seasonal febrile illness. Although, various humoral immune responses to scrub typhus have been documented, no association between gammopathy and scrub typhus has ever been reported. We analyzed the incidences and types of monoclonal and biclonal gammopathies in scrub typhus for better coping with those gammopathies in scrub typhus. METHODS: Anti-Orientia tsutsugamushi antibody-positive sera identified by indirect immunofluorescence assay were acquired from 40 patients with confirmed scrub typhus. Monoclonal and biclonal gammopathies were screened by protein electrophoresis and were confirmed using immunofixation electrophoresis (IFE). Laboratory findings on admission of the patients with monoclonal or biclonal gammopathy were investigated retrospectively to characterize the gammopathies. RESULTS: Monoclonal or biclonal gammopathies were detected in 30% (12/40) of patients with scrub typhus (IgG-lambda, 40%; IgG-kappa, 30%; IgM-kappa, 10%; IgM-lambda, 10%; IgA-kappa, 5%; IgA-lambda, 5%). Concentrations of clonal immunoglobulin were less than 3 g/dL in all gammopathies, and hypercalcemia was not detected in any of the patients. CONCLUSIONS: Our results suggest possible association between gammopathies and scrub typhus. Further studies in larger series will be needed for exact incidence and clinical course of gammopathies in scrub typhus.
Assuntos
Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Cadeias Pesadas de Imunoglobulinas/sangue , Cadeias Leves de Imunoglobulina/sangue , Imunoglobulina M/sangue , Incidência , Orientia tsutsugamushi/imunologia , Paraproteinemias/complicações , Estudos Retrospectivos , Tifo por Ácaros/complicaçõesRESUMO
Multiple myeloma is lethal plasma cell proliferation that produces monoclonal M-protein and presents bone pain, pathologic fractures, anemia, hypercalcemia, renal failure, abnormalities of the coagulation system, and dysfunctions of the nervous system. About 1% of the multiple myeloma have more than one such protein (monoclonal M-protein). We experienced a case of mutiple myeloma presented as biclonal gammopathy. Protein electrophoresis and immunoelectrophoresis showed biclonal band that consisted of IgG-landa and IgA-k.
Assuntos
Anemia , Eletroforese , Fraturas Espontâneas , Hipercalcemia , Imunoeletroforese , Mieloma Múltiplo , Sistema Nervoso , Plasmócitos , Insuficiência RenalRESUMO
Two M-protein peaks in serum protein electrophoresis are rarely present in patients with plasma cell discrasia. We describe a 72-year-old male patient with multiple myeloma secreting biclonal M-proteins, which were confirmed by immunofixation. Immunoelectrophoresis has some difficulties to dectect M components when a very small amount of M-protein develops an equivocally abnormal precipitation arc. In this case, serum protein electrophoresis revealed two M peaks, one in beta and the other in gamma globulin region. An immunoelectrophoresis revealed unequivocally abnormal precipitation arcs in IgA and K light chain regions, but the arc in IgG region was equivocal. We performed an immunofixation and confirmed biclonal gammopathy, IgA-K and IgG-K types. This result supports the view that immunofixation is an useful confirmatory test when immunoelectrophoresis results are equivocal.
Assuntos
Idoso , Humanos , Masculino , Eletroforese , gama-Globulinas , Imunoeletroforese , Imunoglobulina A , Imunoglobulina G , Mieloma Múltiplo , Proteínas do Mieloma , PlasmócitosRESUMO
Multiple myeloma is a disease originated from plasma cell line. A single protein is generally produced by myeloma cells, but a few cases of biclonal gammopathy are reported. We experienced a case of multiple myeloma, a 53-year-old woman, with IgG and IgA biclonal gammopathy. She has maintained in complete remission after 6 cycles of combination chemotherapy with cyclophosph- amide, vincristine, adriamycin, and prednisolone.