Dr. Goswami Parth Rajendragiri
Pathology
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
Hello doctor,
I am a 53-year-old female. My BMI is 21. I have multiple complex symptoms over time, especially polyarthralgia, maculopapular body rashes, hypertension, photosensitivity, tension headaches, fatigue, bone and body pain, numerous infections in kidney, chest, ears, mouth, nose, bladder, suspected sepsis, SIRS, bacteriosis, tachycardia with bursitis.
Elevated plasma viscosity, D-dimer, IgA, diagnosed MGUS with kappa lambda light chain M spike protein 2.9, eosinophilia, neutropenia, monocytosis, stomatocytes, epithelial cells, rouleaux formation, eosinophilia mild, and three small liver lesions with 1 cm tumor, mitral heart irregularity. All continuing after five blood panels, neutrophil shift 0.7 continues dropping. TSH and T4 borderline, other results are broadly normal.
Urine negative Bench Jones but elevated adrenaline. Negative RF, RA. No immunity irregularities and mild vitamin D deficiency.
Patient is a vegetarian, average smoker with mild alcohol consumption. What are the signs of MGUS progression? What are the diagnostic tests and why? Continued pain medicines for severe arthritic hand, finger, foot, toe pain, cramps. I also had ligament damage from small household events, significant reactions, bruising, inflammation, itching, nasal congestion, and bleeding. Please help. I am currently on Prozac, Tramadol, Ibuprofen, antihistamine, and Vitamin D.
Hello,
Welcome to icliniq.com.
According to history, you have been diagnosed with MGUS (monoclonal gammopathy of undetermined significance). But now, due to increased viscosity in blood by monoclonal paraproteins, you have symptoms like hypertension, headache, rash, etc.
So as per my opinion, it could be the progression of MGUS, and you should rule out multiple myeloma by bone marrow aspiration study and serum protein immunofixation electrophoresis. Bone marrow conclusive in rule out multiple myeloma. If it is detected than treatment can be done for that. Urine Bence Jones protein detection is not diagnostic to rule out multiple myeloma.
Inflammation due to ligament injury can be treated by anti-inflammatory medicine.
For septicemia, blood culture is needed and antibiotic given accordingly. Your ANA level also should be checked to screen for the autoimmune disorder as well. You should consult a good internal medicine specialist for your physical examination and management.
Patient's Query
Thank you doctor,
Your overall diagnosis is what I expected, but please can you provide a more detailed hematological technical explanation. Which blood results are the most important indication that MGUS has progressed? You have not mentioned the lesions found on my liver or the mitral heart damage. Could this also be related to MM? Paraproteins need more explanation. Do they potentially relate to the neutropenia and, therefore, the T4 and TSH, or is there a possibility of hypothyroidism?
Hi,
Welcome back to icliniq.com.
In your attached reports (attachment removed to protect patient identity), it has been written that monoclonal immunoglobulin present. A/G ratio altered. Plasma viscosity increased. So you are having plasma cells dyscrasia for sure.
You have been diagnosed as MGUS in the past. So bone marrow might have done at that time, and your plasma cells might be less than 10%. So such diagnosis is made.
But let me clear that now you are symptomatic with bone pain, hypertension, headache, etc., which is usually not seen in MGUS. And more importantly, your neutrophils are down consistently, which might be due to the replacement of hematopoietic cells by myeloma cells. Hence it seems to be a progression of MGUS. So, I suggest you investigate with bone marrow, which will reflect the exact percentage of plasma cells and so multiple myeloma can be ruled out.
Rolex formation in the blood is due to this plasma cell disorder either due to MGUS or myeloma. Stomatocytes mentioned in your history could be due to mild hemolysis in blood and do not need much attention.
Your liver lesion is not related to multiple myeloma most probably. I cannot open the liver scan report fully. Only first page is visible. Kindly upload the CT scan and liver scan report in PDF file so I can check it.
Mitral valve irregularities could be due to increasing plasma viscosity for which 2D echocardiography needs to be done. Your SGPT, serum calcium, urea, creatinine reports are not attached herewith.
For vitamin D deficiency, a cholecalciferol sachet can be given.
Paraprotein means abnormal monoclonal protein, which is present in you due to either MGUS or multiple myeloma. Eosinophilia could be due to some form of allergic problems.
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Pathology
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