Appearance of monoclonal gammopathy and auto-immune hemolytic anemia following intake of drugs
Mitsutani, S.
Nihon Ketsueki Gakkai Zasshi Journal of Japan Haematological Society 48(3): 849-852
1985
ISSN/ISBN: 0001-5806 PMID: 4036524 Document Number: 258898
A 64-yr-old man was presented with a weight loss of 10 kg, palpitation, general fatigue and fever. He was receiving diclofenac sodium (75 mg/day) and chlormesanone (300 mg/day) for about a year because of sciatica. There was no lymphadenopathy or organomegaly. Laboratory data was as follows: RBC 2.15 .times. 1012/l; a Coombs' test positive with anti-IgG and anti-.kappa. karyotype normal; IgA 270 mg/dl; IgG 4580 mg/dl and IgM 86 mg/dl in the serum; IgG .lambda. monoclonal protein detectable on immunoelectrophoresis; tuberculin reaction negative. In the bone marrow, large intermediate lymphoplasmacytic cells proliferated in a cluster. X-ray examination disclosed no osteolytic lesions. After cessation of intake of the drugs mentioned above followed by corticosteroid therapy, his anemia rapidly decreased and his body weight was fully restored. About a year later, he was additionally given cyclophosphamide (50 mg/day) because of continued paraproteinemia. Subsequently, both the serum monoclonal protein and abnormal cells in the bone marrow disappeared 16 mo. later, and furthermore the positive Coombs' test became negative. Even after he stopped taking medication over the following 2 yr, both the serum monoclonal protein and the red cell auto-antibody have remained negative, and the symptoms have not recurred. Time sequence of events in this patient seems to suggest an association between immunological abnormality and drug intake, rather than the diagnosis of an unusually sensitive B-cell neoplasm. The combination of such immunological abnormalities as shown in this patient, namely monoclonal gammopathy (MG) accompanied by autoimmune hemolytic anemia (AIHA) is quite uncommon, regardless of whether it is neoplastic or benign. MG and AIHA are both known to be associated with angioimmunoblastic lymphadenopathy, which is occasionally induced by some drugs. One drug, diclofenac sodium, which could be responsible for the hematological episodes in this patient does indeed chemically resemble mefenamic acid, which may cause the development of AIHA.