Dr. Anshul Varshney
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I recently had a serum primary effusion lymphoma (PEL) immunofixation electrophoresis (IFE) with a free light chain analysis. PEL and IFE were normal, but elevated kappa 39.86 mg/L and lambda 19 mg/L with the ratio of 2:1. The test was done due to persistent and worsening polyneuropathy. Currently, I am having confusion and significant short-term memory loss. I have a previous history of confirmed neurological Lyme disease and Bartonella before three years. I appreciate any of your thoughts.
Hi,
Welcome to icliniq.com. We are here to help you. These reports need evaluation for the cause of multiple myeloma. However, I do not strongly suspect it based on these reports as a lot of the asymptomatic general population has an elevated kappa chain with no significance. Still, a bone marrow examination is recommended. To support the evidence of multiple myeloma, I would recommend you to get serum calcium and urine for Bence Jones protein. This needs to be evaluated properly. If the bone marrow is normal, then this is not the cause behind this.
Patient's Query
Thank you doctor,
Are my neuropathy, confusion and memory loss the symptoms of amyloidosis?
Hi,
Welcome back to icliniq.com. They are not the classical symptoms of amyloidosis. I would recommend you to get your thyroid profile, vitamin B12 levels and MRI brain done to rule out these most common causes behind the memory loss, confusion and neuropathy. In case they have been performed, please share your reports with me.
Patient's Query
Thank you doctor,
All laboratory investigations for neuropathy including toxins and metals have been normal. Only Lyme, Bartonella and this free light chain are positive related to neuropathy and that has some autonomic involvement with my bladder.
Hi,
Welcome back to icliniq.com. With the discussions, it is very unlikely to be myeloma or amyloidosis.Lyme disease is the probable cause of your symptoms and central nervous system (CNS) Lyme explains all your symptoms. However, if vitamin B12 levels are not performed, then you should go ahead for them. I am sure that your Lyme must have been treated by now, but theresidual neurological issues can be permanent. I would suggest Coenzyme Q10 supplement for this purpose. Consult your specialist doctor, discuss with him or her and take the medicine with consent. In case if you have any limb rigidity associated, Prion disease (neurodegenerative conditions) should also be concerned.
Patient's Query
Thank you doctor,
I appreciate it and I hope that is the case. I have been unable to find anything that says free light chains are not significant. Would infection while on antibiotics cause such type of disease? I forgot to include my laboratory reports. It was done when cognitive symptoms really exploded in the late winter or spring and the most recent complete blood count (CBCs) I have.
Hi,
Welcome back to icliniq.com. The attached reports are in accordance with our discussion (attachment removed to protect patient identity) and do not reveal anything new.
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Internal Medicine
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