Le Cann et al reported the worup of a patient with a neurologic monoclonal gammopathy of clinical significance. The authors are from multiple institutions in France.
Presentation:
(1) monoclonal gammopathy
(2) neuropathy
(3) abnormal concentrations of serum free light chains
Investigation:
(1) nerve conduction studies (to distinguish demyelinating versus axonal pattern)
(2) detection of antibodies (anti-myelin-associated glycoprotein = MAG, anti-ganglioside)
(3) screening for significant clinical features (possible clues to an alternative diagnosis)
Significant clinical features:
(1) pain
(2) rapidly evolving course
(3) multifocal topography
(4) dysautonomia
(5) weight loss
(6) skin changes
(7) organ dysfunction (cardiac, pulmonary, hepatic, renal)
(8) cold agglutinins
Differential diagnosis:
(1) amyloid neuropathy
(2) cryoglobulinemia (versus antibody-mediated)
(3) tumor nerve infiltration
