Inatomi Y, Gotoh A, Kuriyama Y, Kuwabara S, Lin K Y, Nakano M, Toyama K
First Department of Internal Medicine, Tokyo Medical College, Japan.
Rinsho Ketsueki. 1996 May;37(5):437-42.
A 56-year-old man was admitted to our hospital in November, 1991 because of hyperproteinemia and anemia. Total protein showed 12 g/dl and serum immunoglobulins were as follows; IgG 974 mg/dl, IgA 142 mg/dl, IgM 9270 mg/dl. M-component was identified as IgM-kappa with immunoelectrophoresis and serum viscosity indicated 6.9. Although the patient had no history of severe streptococcal infection, his serum showed very high activity of ASLO (6890 IU/ml). Bence Jones protein was detected in the urine and determined to be of kappa-type. Plasma cells occupied 43% of bone marrow nucleated cells and their cytoplasms were stained with FITC-labeled anti-IgM and anti-kappa antibodies. X-ray examination disclosed punched out lesions in the skull. Consequently, the patient was diagnosed as having IgM-myeloma. At first, VCAP regimens were given after plasmapheresis, but had no effect. Therefore, the patient was treated with CHOP protocol and the serum IgM decreased in amount and the proportion of bone marrow myeloma cells got down to 17%. ASLO titer also decreased in parallel with IgM. These findings suggest that IgM in this case had ASLO activity.
一名56岁男性于1991年11月因高蛋白血症和贫血入住我院。总蛋白显示为12g/dl，血清免疫球蛋白如下：IgG 974mg/dl，IgA 142mg/dl，IgM 9270mg/dl。通过免疫电泳鉴定M成分是IgM-κ，血清粘度为6.9。尽管该患者无严重链球菌感染病史，但其血清抗链球菌溶血素O（ASLO）活性非常高（6890IU/ml）。尿液中检测到本周氏蛋白，确定为κ型。浆细胞占骨髓有核细胞的43%，其细胞质用异硫氰酸荧光素（FITC）标记的抗IgM和抗κ抗体染色。X线检查显示颅骨有穿凿样病变。因此，该患者被诊断为IgM骨髓瘤。起初，在血浆置换后给予VCAP方案，但无效。因此，该患者接受了CHOP方案治疗，血清IgM量减少，骨髓骨髓瘤细胞比例降至17%。ASLO滴度也与IgM平行下降。这些发现提示该病例中的IgM具有ASLO活性。
