A Case of IgE Myeloma: Methodology and Review of the Literature

A 56-year-old man presented with a one-year history of progressive weakness predominantly affecting his extremities and persistent low back pain. Ouchterlony immunodiffusion of the concentrated urine detected a marked increase in lambda light chains. A sternal bone marrow documented a diagnosis of multiple myeloma. Screening high resolution agarose gel electrophoresis revealed diffuse hypogammaglobulinemia and, retrospectively, an equivocal, faint band which migrated in the fast gamma region. By using a combination of Immunoelectrophoresis and immunofixation electrophoresis, this questionable band was determined to represent an IgE lambda monoclonal protein. Radioimmunoassay for IgE documented a serum concentration of 50.6 mg/dl. No intact IgE was found in the urine. Following chemotherapy, the patient\u27s serum IgE level decreased significantly, and he is presently asymptomatic. Features of special interest in this case include the low serum IgE level on presentation, which was difficult to detect on the screening electrophoretogram, and the use of immunofixation electrophoresis in the detection and characterization of these difficult gammopathies

Nocardia Asteroides aortitis with perforation of the aorta

A 53-year-old man died of nocardial aortitis eight months after undergoing aortic valve replacement. Autopsy revealed vegetation in the area of a previous aortotomy incision and a small perforation of the aorta enclosed by pericardium immediately above the prosthetic valve ring. Prosthetic valve endocarditis was not present. Multiple splenic infarcts, microabscesses of both kidneys, and myocarditis were identified. Antemortem blood cultures and postmortem cultures of the aortic vegetation grew Nocardia asteroides