Muscle pain as a rare autoimmune symptom of monoclonal IgM gammopathy – case report and overview of autoimmune manifestations associated with monoclonal immunoglobulins

Czech version

Authors: Z. Král; M. Krejčí; L. Pour; Z. Adam
Authors‘ workplace: Interní hematologická a onkologická klinika LF MU a FN Brno
Published in: Transfuze Hematol. dnes,27, 2021, No. 1, p. 57-61.
Category: Case Report
doi: https://doi.org/10.48095/cctahd202157

Overview

This article describes a rare case of Waldenström’s macroglobulinemia with autoimmune myopathy and presents a short overview of other possible autoimmune manifestations associated with the presence of monoclonal immunoglobulin (MIg). In our patient, Waldenström’s macroglobulinemia manifested as chronic muscle pain and anaemia. The patient suffered from back muscle pains for about 3 years before being diagnosed with WM, with progression of myalgia and pain of the upper and lower limbs in the last year prior to diagnosis. Serum myoglobin and creatinkinase (CK) levels were significantly increased. Polymyositis was not confirmed. The diagnosis of WM was established in 2014, with typical infiltration with lympho-plasmacytoid lymphoma in the bone marrow and the presence of IgM lambda paraproteinemia in the serum. The patient started treatment with the anti-CD20 monoclonal antibody rituximab, cyclophosphamide and dexamethasone and received 8 cycles from 7/2014–2/2015. The IgM disappeared, the immunofixation results normalised as did myoglobin, CK and haemoglobin after the 5^th cycle and there was significant improvement of muscle pain. The patient achieved a complete remission with no signs of relapse/progression at the last follow-up in 12/2019 with normal or only mildly elevated CK and myoglobin.

Keywords:

Waldenström’s macroglobulinemia – autoimmune myopathy – rituximab

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