Italian 
English Assenza di bande monoclonali liquorali e positività del rispettivo indice siero-liquor: una discrepanza da indagare attenatamente
Absence of liquoral monoclonal bands and positivity of the respective serum-liquor index: an unespected findings to be carefully investigated
AUTORI
Giorgio Bellomo2, Umberto Dianzani2, Ilaria Crespi1
1Laboratorio di Biochimica Clinica, Azienda Ospedaliera-Universitaria Maggiore della Carità di Novara
2Dipartimento di Scienze della Salute, Università del Piemonte Orientale
ABSTRACT
Absence of liquoral monoclonal bands and positivity of the respective serum-liquor index: an unespected findings to be carefully investigated
A 13 year-old child whit headache, nausea and repeated episodes of vomiting was hospitalized at the Major Hospital of Charity of Novara. A lumbar puncture and biochemical investigations on cerebrospinal fluid (CSF) including oligoclonal bands (OCB) screen were performed. Kappa and Lambda free light chains (kFLC and λFLC) and IgG concentrations were measured in serum and CSF by nephelometry. OCB were evaluated by isoelectric focusing (IEF) followed by immunofixation (IMF). A negative IgG index, no OCB IgG (type I pattern), positive kFLC index with increased levels of kFLC (0.14 mg/dL) and λFLC (0.14 mg/dl in CSF) were found. The FLC data suggested an intrathecal synthesis. A CSF IMF was then performed using anti-IgM peroxidase together with the IgM index using Reiber’s hyperbolyc graphic. The presence of a monoclonal IgM band and 76% of intrathecal IgM synthesis was demonstrated. A subsequent molecular biology investigation was performed on CSF and revealed a clear positivity for enterovirus.