Hepatitis C virus infection-associated non-cryoglobulinaemic monoclonal IgMkappa gammopathy responsive to interferon-alpha treatment.
OBJECTIVE
An association of HCV infection with lymphoproliferative disorders, particularly B-cell non-Hodgkin's lymphoma has been described. In the majority of reported patients, mixed cryoglobulinaemia was present as well. Rarely, HCV-associated lymphoproliferative disorders have been observed in the absence of cryoglobulinaemia. In these latter patients, the response to interferon-alpha is largely unknown.


METHODS
We report a case of an asymptomatic 31-year-old male with chronic HCV infection and non-cryoglobulinaemic monoclonal IgMkappa gammopathy responsive to interferon-alpha therapy. Prior to therapy, elevated plasma transaminase activities known for longer than a year, serum anti-HCV antibodies and HCV RNA detected by reverse transcriptase-polymerase chain reaction were present. Serum IgM concentration was markedly elevated, immunofixation demonstrated monoclonal serum IgM, and urine kappa-light chains were detected. Cryoglobulins were undetectable in several consecutive serum samples. Bone marrow aspirate and biopsy specimens were unremarkable. Further evaluation, e.g. by ultrasonography and radiography, did not reveal evidence for lymphoma. Treatment with interferon-alpha2a for 12 months resulted in a long-term sustained response to HCV infection and in a normalisation of serum IgM concentration.


CONCLUSIONS
Therefore, the corresponding effects of interferon-alpha on HCV infection and on a monoclonal B-cell population observed in the present case might suggest a pathogenetic connection, similarly, to what has been described for HCV and mixed cryoglobulinaemia. The molecular events, however, leading to HCV-induced monoclonal B-cell expansion remain unknown.
Department of Medicine, Georg-August-Universität, Göttingen, Germany.
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P
Schott
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C
Pott
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G
Ramadori
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H
Hartmann
D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology; D001707:Biopsy, Needle; D015321:Gene Rearrangement; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D006942:Hypergammaglobulinemia / Q000150:complications / Q000628:therapy; D007075:Immunoglobulin M / Q000097:blood*; D007145:Immunoglobulin kappa-Chains / Q000652:urine*; D007146:Immunoglobulin lambda-Chains / Q000097:blood; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use*; D008099:Liver / Q000473:pathology; D008297:Male; D010265:Paraproteinemias / Q000150:complications* / Q000628:therapy*; D012367:RNA, Viral / Q000097:blood; D011994:Recombinant Proteins; D014779:Virus Replication
D007075:Immunoglobulin M; D007145:Immunoglobulin kappa-Chains; D007146:Immunoglobulin lambda-Chains; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins