biochimica clinica

en_US English
en_US English it_IT Italian

CASI CLINICI – Case Reports

Volume:

Biochimica Clinica, aop

Pubblicato on-line:

November 7, 2024

DOI:

10.19186/BC_2024.062

Scarica in PDF:
Autenticazione richiesta

Un aspetto non comune di bande oligoclonali nel liquor

AUTORI

Daniele Frattolillo1, Antonio Cortese2, Laura De Giglio2, Elisabetta Ferraro2, Marina Vitillo1 1UOC Patologia Clinica, Dipartimento dei laboratori, P.O. S. Filippo Neri, ASL Roma 1; 2 Centro Sclerosi Multipla, UOC Neurologia, Dipartimento delle Specialità Mediche, P.O. S. Filippo Neri, ASL Roma 1

ABSTRACT

An uncommon oligoclonal band pattern in cerebrospinal fluid

A 53-years old woman accessed the Eye Clinic for vision loss and eye pain, symptoms suggesting optical neuritis. Basic biochemical tests were all within the reference ranges. Anti-aquaporin 4 and anti-myelin oligodendrocyte glycoprotein antibodies were negative as well as syphilis and HIV serology. Magnetic Resonance Imaging showed demyelinating lesions in corona radiata and optical nerve. Cerebrospinal fluid (CSF) examination was normal. Patient was in follow up for an IgG kappa monoclonal gammopathy. Isoelectrofocusing of CSF and serum showed an uncommon pattern with presence of the monoclonal component plus restricted oligoclonal bands in CSF only, consistent with intrathecal IgG synthesis. These findings aided the diagnosis of multiple sclerosis. The interest of this clinical report lies in its rarity. It is not clear whether a causal link can be hypothesized between the monoclonal gammopathy and intrathecal synthesis or whether, more likely, this is a fortuitous finding of two coexisting phenomena.

BIBLIOGRAFIA

  1. Bassem Y, Raed A. Multiple Sclerosis. Semin Neurol 2018;38:212-25.
  2. Thompson AJ, Banwell BL, Barkhof F, Carrol WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018;17:162-73.
  3. Andersson M, Alvarez-Cermeño J, Bernardi G, Cogato I, Fredman P, Frederiksen J, et al. Cerebrospinal fluid in the diagnosis of multiple sclerosis: a consensus report.  J Neurol Neurosurg Psychiatry 1994;57:897-902.
  4. Rentzos M, Michalopoulou M, Gotosidis K, Caponi A, Bonakis A, Kilidireas K, et. Al. Unusual association of multiple sclerosis with monoclonal gammopathy of undetermined significance (MGUS): two case reports. Funct Neurol 2004;19:253-6.
  5. Tréfouret S, Azulay JP, Puget J, Boucraut J, Serratrice G. Late-onset multiple sclerosis and serum monoclonal gammopathy: an incidental association? Rev Neurol 1996;152:554-6.
  6. Mehra V, Rohne E, Widya S, Zuckerman M, Potter V, Raj K. Epstein-Barr Virus and Monoclonal Gammopathy of Clinical Significance in Autologous Stem Cell Transplantation for Multiple Sclerosis. Clin Infect Dis 2019;69:1757-63.
  7. Pourmohammadi A, Naghavi S, Adibi I. Recurrent Optic Neuritis as the first presentation of Monoclonal Gammopathy of Undetermined Significance (MGUS): A Case Report. Ann Clin Case Rep 2022;7:2304.
  8. Galiè E, Dell’Acqua ML, Maschio M, Koudriavtseva T, Marco ED, Jandolo B. Central and peripheral neurological involvement in monoclonal gammopathies of undetermined significance. World J of Neuroscience 2013;3:282-6.
  9. Dispenzieri A. POEMS Syndrome: 2019 Update on diagnosis, risk-stratification, and management. Am J Hematol 2019;94:812-27.
  10. Sobol U, Stiff P. Neurologic aspects of plasma cell disorders. Handb Clin Neurol 2014;120:1083-99.