1986 Volume 9 Issue 6 Pages 476-483
A 58-year-old female, who suffered from general fatigue and faint attack since 1983, was admitted to our hospital because of further examination for hypogammaglobulinemia in August 17, 1984. On admission increased erythrocyte sedimentation rate and rouleaux formation were demonstrated, but total protein had diminished to 6.3 g/dl with 8.2% γ-globulin. Fundic examination demonstrated sausage-like change in vein and she was diagnosed as hyperviscosity syndrome. Whether thermoprotein existed or not was examined, and cryogelglobulin was detected, although she didn's have Raynaud's symptom. Cryogelglobulin was 60% in cryocrit. Her serum was separated into supernatant serum and gel fraction. Monoclonal peak on γ-region was observed in the whole serum and its gel fractions, and IgM was 2, 700 mg/dl in the whole serum and 3, 360 mg/dl in the gel fraction, while hypogammaglobulinemia was recognized in supernatant serum. Serum protein study revealed that cryogelglobulin consisted of monoclonal IgM, k and polyclonal IgG. Bone marrow aspiration revealed that the frequencies of plasma cells was 5.2% and that of lymphocytoid cells 1.6%.
Thus, she was diagnosed as primary macroglobulinemia with mixed cryogelglobulin. After administration of procarbazine, she remained asymptomatic and the cryocrit diminished from 60% to 31%.
