病例报告：意义未明的单克隆丙种球蛋白病与感染相关。
Case Report: Monoclonal Gammopathy of Undetermined Significance is Associated with Infection.
机构信息
Department of Pathology, State University of New York, Downstate Medical Center and Kings County Hospital Center, Brooklyn, New York.
Department of Medicine, State University of New York, Downstate Medical Center and Kings County Hospital Center, Brooklyn, New York.
出版信息
Am J Trop Med Hyg. 2018 Nov;99(5):1206-1210. doi: 10.4269/ajtmh.18-0351.
A 63-year-old woman who migrated from Nigeria to the United States was found to have an elevated total serum protein, anemia, and eosinophilia. Serum protein electrophoresis (SPEP) and serum protein immunofixation electrophoresis (SPIFE) demonstrated monoclonal immunoglobulin G (IgG) κ restricted bands (IgG 3,820 mg/dL; κ/λ ratio 4.47), indicative of monoclonal gammopathy of unknown significance (MGUS). A rapid diagnostic test (RDT) for malaria was positive for (BinaxNOW; Alere Scarborough Inc., Scarborough, ME). Giemsa-stained blood smears were negative for malarial parasites, however, microfilariae were identified. Reverse transcription polymerase chain reaction for , , , and yielded a negative result. She was treated for loiasis with diethylcarbamazine and received no malaria medication. Treatment resulted in a resolution of the microfilaremia and eosinophilia, a negative RDT for malaria, and marked reduction in the monoclonal gammopathy. This is the first reported human case of MGUS associated with loiasis and its resolution after antiparasitic treatment.
一位 63 岁的尼日利亚女性移民到美国后，被发现总血清蛋白升高、贫血和嗜酸性粒细胞增多。血清蛋白电泳（SPEP）和血清蛋白免疫固定电泳（SPIFE）显示单克隆免疫球蛋白 G（IgG）κ受限带（IgG3820mg/dL；κ/λ 比值 4.47），提示意义未明的单克隆丙种球蛋白病（MGUS）。疟疾快速诊断检测（RDT）呈阳性（BinaxNOW；Alere Scarborough Inc.，Scarborough，ME）。吉姆萨染色血涂片未发现疟原虫，但发现微丝蚴。针对 、 、 、 和 的逆转录聚合酶链反应结果均为阴性。她接受了伊维菌素治疗并接受了抗疟疾药物治疗。治疗后微丝蚴血症和嗜酸性粒细胞增多得到缓解，疟疾 RDT 转为阴性，单克隆丙种球蛋白病显著减轻。这是首例与旋毛虫病相关并在寄生虫治疗后得到缓解的 MGUS 人类病例。
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