Serum protein electrophoresis (SPE) demonstrates a monoclonal protein as an M spike in the majority of patients with monoclonal gammopathies. However, in patients with an apparently normal SPE pattern or hypogammaglobulinemia, immunofixation electrophoresis (IFE) can reveal an M protein. We undertook this study to determine the yield of reflex IFE testing in patients with hypogammaglobulinemia and to identify any laboratory or biochemical parameters that would predict a positive IFE result. We evaluated 380 patients with hypogammaglobulinemia and a normal SPE pattern. Of 380, 37 (9.7%) had a positive IFE result in serum, urine, or both. Of the other laboratory values evaluated, a high alpha2-globulin level with an increased alpha2-globulin/alpha1-globulin ratio, a low hemoglobin level, and an elevated creatinine level predicted a positive IFE result. There was a 2-fold increase in the odds ratio for a positive IFE result when the alpha2-globulin/alpha1-globulin ratio was elevated. We recommend reflex IFE testing in patients with hypogammaglobulinemia with a normal SPE pattern if any of the following are present: elevated alpha2- globulin/alpha1-globulin ratio, low hemoglobin level, and elevated creatinine level.
Mucormycosis is an aggressive fungal infection characterized by rapidly progressive angioinvasion and tissue necrosis. When present in the orbit, mucormycosis can quickly lead to permanent visual loss and potentially fatal cerebral extension. Orbital involvement is almost universally preceded by infection of the paranasal sinuses. Secondary infection of the orbit via direct extension of neighboring cutaneous mucormycosis has not been previously described. The authors present a case of cutaneous mucormycosis with orbital extension in a poorly controlled diabetic patient.
A 2-month-old male infant presented with a subcutaneous mass on the left middle finger; the mass had been present since birth. This was treated with local excision, and there has been no recurrence. Histology revealed the typical features of a fibrous hamartoma. Cytogenetic studies revealed a reciprocal translocation, t(2;3)(q31;q21), as the sole abnormality. To our knowledge, this is the first report of the cytogenetic findings in fibrous hamartoma, and it suggests that this lesion represents a benign neoplasm.
While coronavirus disease 2019 (COVID-19) is well known to cause significant lower respiratory symptoms, recent literature has documented numerous cases of multi-systemic involvement that can present with atypical symptoms. We report a case of an 83-year-old man, recovering from abdominal aortic aneurysm repair complicated by colonic injury requiring colostomy rendering him dependent on gastrostomy tube feedings for 3 years, who was transferred from a nursing care facility to the emergency department with altered mental status, fever and jaundice. Abdominal imaging and biopsy studies eventually identified duodenitis and ampullitis complicated by a suspected Klatskin tumor leading to biliary obstruction, sepsis and hepatoencephalopathy. Polymerase chain reaction (PCR) for COVID-19 was positive. Despite the severity of the initial presentation, the patient had no respiratory symptoms or abnormal chest X-ray findings on admission and developed hypoxia late into the disease course. Thus, this case is a report of an abnormal initial COVID-19 presentation with gastrointestinal and hepatobiliary involvement leading to hepatoencephalopathy but no lung findings, highlighting the importance of investigating extrapulmonary processes in COVID-19-positive patients regardless of pulmonary symptoms.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.