Skip to main content
SpringerLink
Log in

Clinical implications of monoclonal gammopathy in chronic liver disease

  • Original Articles
  • Published:
The American Journal of Digestive Diseases Aims and scope Submit manuscript

Abstract

An association between chronic liver disease and monoclonal gammopathy is described in 7 patients. Three cases had cold precipitable IgG-IgM complexes. Two of them manifested a syndrome of ulcerative purpura, Raynaud's phenomena, arthritis, neuropathy, encephalopathy, myopathy, and terminal glomerulonephritis. Two additional cases had occasional purpura and in 2 cases the gammopathy was asymptomatic. In 1 patient, monoclonal gammopathy developed from polyclonal gammopathy in the course of the disease, and transition to malignant lymphoma occurred several months later. Prednisone, ACTH, and azathioprine, had no appreciable effect on the cryoglobulinemia. In 2 cases, the monoclonal fraction disappeared or decreased with prednisone alone and prednisone and chlorambucil respectively.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lee FI: Immunoglobulins in viral hepatitis and active alcoholic liver disease. Lancet 2:1034–1036, 1965

    Google Scholar 

  2. Gelzayd EA, Kirsner JB: Immunologic aspects of chronic active hepatitis in young people: a critical review of the, recent literature. Am J Med Sci 253:98–109, 1967

    Google Scholar 

  3. Feizi T: Immunoglobulins in chronic liver disease. Gut 9:193–198, 1968

    Google Scholar 

  4. Deicher H, Otto P, Gleichmann E: Quantitative serum immunoglobulin determinations in active chronic hepatitis and idiopathic cirrhosis, Current Problems in Immunology Edited by O Westphal, HE Bock, E. Grundmann. New York, Springer-Verlag New York Inc., 1969, pp 238–244

    Google Scholar 

  5. Havens WP Jr, Schaffner, JM, Hopke CJ Jr: Production of antibody by patients with chronic hepatic disease. J Immunol 67:347–356, 1951

    Google Scholar 

  6. Havens WP, Jr, Myerson RM, Klatchko J: Production of tetanus antitoxin by patients with hepatic fibrosis, N Engl J Med 257:637–643, 1957

    Google Scholar 

  7. Triger DR, Alp MH, Wright R: Bacterial and dietary antibodies in liver, disease. Lancet 1:60–63, 1972

    Google Scholar 

  8. Triger DR, Kurtz JB, MacCallum FO, Wright R: Raised antibody titres to measles and rubella viruses in chronic active hepatitis. Lancet, 1:665–667, 1972

    Google Scholar 

  9. Bjørnboe M, Prytz H, Ørskov F: Antibodies to intestinal microbes in serum of patients with cirrhosis of the liver. Lancet 1:58–60, 1972

    Google Scholar 

  10. Jarrold T, Vilter RW: Hematologic observations in patients with chronic hepatic insufficiency. Sternal bone marrow morphology and bone marrow plasmocytosis. J Clin Invest 28:286–292, 1949

    Google Scholar 

  11. Zlotnick A, Karshai A: The bone marrow of patients with hypergammaglobulinemia. Isr J Med Sci 20:1–14, 1961

    Google Scholar 

  12. Eliakim M, Zlotnick A, Slavin S: Gammopathy in liver disease, Progress in Liver Disease. Edited by H Popper, F Schaffner, New York, Grune & Stratton, Inc (In press, 1972)

    Google Scholar 

  13. Waldenstrom J: Clinical diagnosis and biochemical findings in material of 296 sera with M-type narrow globulins. Acta Med Scand (Suppl 367) 170:110–126, 1961

    Google Scholar 

  14. Hallen, J: Discrete gammaglobulin (M) components in serum. Clinical study of 150 subjects without myelomatosis. Acta Med Scand (Suppl 462) 1–127, 1966

    Google Scholar 

  15. MacKay IR, Erikson, N, Motulski AG, Volwiler W: Cryo-and macroglobulinemia. Electrophoretic, ultracentrifugal and clinical studies. Am J Med 20:564–587, 1956

    Google Scholar 

  16. Osserman EF, Takatsuki K: Considerations regarding the pathogenesis of the plasmacytic dyscrasias. Ser Haematol 4:28–49, 1965

    Google Scholar 

  17. Zawadzki ZA, Edwards GA: Dysimmunoglobulinemia associated with hepatobiliary disorders. Am J Med 48:196–202, 1970

    Google Scholar 

  18. Ritzmann SE, Levin WC: Polyclonal gammopathies. Lab Synopsis 2:9–50, 1967

    Google Scholar 

  19. Dupuy MR: Cirrhose ethylique compensée, purpura inflammatoire et cryoglobulinemielymphosarcome, Arch Fr Mal App Dig 56:961–964, 1967

    Google Scholar 

  20. Eliakim M, Slavin S, Zlotnick A: Chronic liver disease associated with mixed cryoglobulinemia. Review of the literature and presentation of two cases. Med Chir Dig 1:67–72, 1972

    Google Scholar 

  21. LoSpalutto J, Dorward B, Miller W, Ziff M: Cryoglobulinemia based on interaction between a gamma macroglobulin and 78 gamma globulin. Am J Med 32:142–147, 1962

    Google Scholar 

  22. Meltzer M, Franklin EC, Elias K, McCluskey RT, Cooper N: Cryoglobulinemia—a clinical and laboratory study. II. Cryoglobulins with rheumatoid factor activity. Am J Med 40:837–856, 1966

    Google Scholar 

  23. Goldberg LS, Barnett EV: Essential cryoglobulinemia. Immunologic studies before and after penicillamine therapy. Arch Inter Med 125:145–150, 1970

    Google Scholar 

  24. Lapes MJ, Davis JS: Arthralgia-purpuraweakness-cryoglobulinemia. Arch Inter Med 126:287–289, 1970

    Google Scholar 

  25. Zinneman HH, Levi D, Seal US: On the nature of cryoglobulins. J Immunol 100:594–603, 1968

    Google Scholar 

  26. Golde D, Epstein W: Mixed cryoglobulins and glomerulonephritis. Ann Inter Med 69:1221–1227, 1968

    Google Scholar 

  27. Feizi T, Gitlin N: Immune-complex disease of the kidney associated with chronic hepatitis and cryoglobulinaemia. Lancet 2:873–876, 1969

    Google Scholar 

  28. Mathison DA, Condemi JJ, Leddy JP, Callerama ML, Panner BJ, Vaughan JH: Purpura, arthralgia and IgM-IgG cryoglobulinemia with rheumatoid factor activity. Response to cyclophosphamide and splenectomy Arch Intern Med 74:383–390 1971

    Google Scholar 

  29. Heimann R: Cirrhosis and lymphoproliferative disorders. Lancet 2:101, 1971

    Google Scholar 

  30. Heimann, R: Cirrhosis and lymphoproliferative disorders. Lancet 2:705, 1971

    Google Scholar 

  31. Amromin GD, Deliman RM, Shanbrom E: Liver damage after chemotherapy for leukemia and lymphoma. Gastroenterology 42:401–410, 1962

    Google Scholar 

  32. Cherrick GR, Pothier L, Dufour JJ, Sherlock S: Immunologic response to tetanus toxoid innoculation in patients with hepatic cirrhosis. N Engl J Med 261:340–341, 1959

    Google Scholar 

  33. Bjørnboe M, Jensen KB, Scheibel I, Thomsen AChr, Bentzon MW: Tetanus antitoxin production and gamma globulin levels in patients with cirrhosis of the liver. Acta Med Scand 188:541–546, 1970

    Google Scholar 

  34. Søborg M, Tygstrup N: Increased cellular immunological response in patients with chronic liver disease. Scand J Gastroenterol (Suppl 7) 5:43–47, 1970

    Google Scholar 

  35. Protell RL, Soloway RD, Martin WJ, Schoenfield LJ, Summerskill WHJ: Anti-Salmonella agglutinins in chronic active liver disease. Lancet 2:330–332, 1971

    Google Scholar 

  36. Askonas BA, Farthing CP, Humphrey JH: Significance of multiple antibody component in serum of immunized rabbits. Immunology 3:336–351, 1960

    Google Scholar 

  37. Catsoulis EA, Franklin EC, Rotschild MA: Cryoglobulinemia in rabbits hyperimmunized with a polyvalent pneumococcal vaccine. Immunology 9:327–331, 1965

    Google Scholar 

  38. Hobbs JR: Paraproteins, benign or malignant? Br Med J 3:699–704, 1967

    Google Scholar 

  39. Waldenstrom J: Macroglobulinemia. Triangle 3:262–270, 1958

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Medicine A, Hadassah University Hospital and Hebrew University-Hadassah Medical School, POB 499, Jerusalem, Israel

    Shimon Slavin MD, Avinoam Zlotnick MSc, MD, Izak S. Levij MD & Marcel Eliakim MD

  2. Hadassah University Hospital and Hebrew University-Hadassah Medical School, POB 499, Jerusalem, Israel

    Shimon Slavin MD, Avinoam Zlotnick MSc, MD, Izak S. Levij MD & Marcel Eliakim MD

Authors
  1. Shimon Slavin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Avinoam Zlotnick MSc, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Izak S. Levij MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcel Eliakim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by Grant 3/70 from the Israel Cancer Foundation.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Slavin, S., Zlotnick, A., Levij, I.S. et al. Clinical implications of monoclonal gammopathy in chronic liver disease. Digest Dis Sci 19, 223–234 (1974). https://doi.org/10.1007/BF01072539

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01072539

Keywords

Search

Navigation