A Case of IgG1-Lambda Multiple Myeloma With Hyperviscosity Syndrome and Cryoglobulinemia: Identification of the Subclass Fraction by Immunoelectrophoresis and Immunofixation Electrophoresis

Kumiyo Tazoe; Naonori Harada; Kazuya Takemura; Mika Nakamae; Masayuki Hino

doi:10.7759/cureus.48253

A Case of IgG1-Lambda Multiple Myeloma With Hyperviscosity Syndrome and Cryoglobulinemia: Identification of the Subclass Fraction by Immunoelectrophoresis and Immunofixation Electrophoresis

Cureus. 2023 Nov 4;15(11):e48253. doi: 10.7759/cureus.48253. eCollection 2023 Nov.

Authors

Kumiyo Tazoe¹, Naonori Harada^{1

2}, Kazuya Takemura³, Mika Nakamae^{4

3}, Masayuki Hino¹

Affiliations

¹ Hematology, Osaka Metropolitan University Hospital, Osaka, JPN.
² Hematology, Fuchu Hospital, Osaka, JPN.
³ Clinical Laboratory, Osaka Metropolitan University Hospital, Osaka, JPN.
⁴ Laboratory Medicine and Medical Informatics, Osaka Metropolitan University Hospital, Osaka, JPN.

Abstract

Hyperviscosity syndrome (HVS) is a complication of monoclonal plasma cell tumors. The frequency of HVS depends on the type of monoclonal protein. Immunoglobulin M (IgM) is more closely associated with HVS than IgG, and among IgG subclass monoclonal proteins, IgG3 is most frequently associated with HVS. We herein report a 44-year-old woman with multiple myeloma (MM), HVS, and cryoglobulinemia. Her monoclonal protein and cryoglobulin were IgG1-lambda (λ). She developed HVS at a lower monoclonal protein level because of the properties of the IgG1-derived monoclonal protein and cryoglobulin. Our case highlights the fact that identifying the IgG subclass is useful in predicting the risk of complicating HVS.

Keywords: cryoglobulinemia; hyperviscosity; igg subclass; multiple myeloma; plasmapheresis.

Publication types

Case Reports