What are the signs of the progression of MGUS?

Question

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 the kidney, chest, ears, mouth, nose, and bladder, suspected sepsis, SIRS, bacteriosis, and tachycardia with bursitis.

My reports show 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, mild eosinophilia, and three small liver lesions with a 0.3-inch tumour, 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, but elevated adrenaline. Negative RF, RA. No immunity irregularities and mild vitamin D deficiency.

I am a vegetarian, an average smoker with mild alcohol consumption. Continued pain medicines for severe arthritic hand, finger, foot, and toe pain and cramps. I also had ligament damage from small household events, significant reactions, bruising, inflammation, itching, nasal congestion, and bleeding. I am currently on Prozac, Tramadol, Ibuprofen, an antihistamine, and Vitamin D.

Here are my concerns:

What are the signs of MGUS progression?
What are the diagnostic tests, and why do I need them?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concerns.

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, in 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 is conclusive in ruling out multiple myeloma. If it is detected, then 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 with anti-inflammatory medicine.

For septicemia, a blood culture is needed, and an antibiotic is given accordingly. Your ANA level should also be checked to screen for the autoimmune disorder. You should consult a good internal medicine specialist for your physical examination and management.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your concern.

In your attached reports (attachment removed to protect patient identity), it has been written that monoclonal immunoglobulin is present. A/G ratio altered. Plasma viscosity increased. So you are having plasma cell dyscrasia for sure.

You have been diagnosed with MGUS in the past. So, bone marrow might have been done at that time, and your plasma cells might be less than 10 percent. So such a diagnosis is made.

But let me clarify 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 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 the 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 the first page is visible. Kindly upload the CT scan and liver scan report in a 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, and 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 problem.

I hope it helps.

Please let me know if I can assist you further.

Thank you.