Acute inflammatory neuropathy with monoclonal anti-GM2 IgM antibodies, IgM-κ paraprotein and additional autoimmune processes in association with a diffuse large B-cell non-Hodgkin's lymphoma

BMJ Case Rep. 2013 Jan 21:2013:bcr1120115087. doi: 10.1136/bcr-11-2011-5087.

Abstract

Lymphoproliferative disorders are often associated with autoimmune processes preceding or following the occurrence of a lymphoma. Here, we describe a patient with a history of recurrent diffuse large B-cell non-Hodgkin's lymphoma who suffered from an acute inflammatory neuropathy with specific monoclonal anti-GM2 IgM antibodies and associated IgM-κ paraprotein. It was possible in this case to prove that both, anti-GM2 IgM antibodies and IgM-κ paraprotein, share the same binding characteristic. In addition, the patient possibly suffered from an immune thrombocytopenia and an early-stage bullous pemphigoid with anti-BP-230 IgG antibodies. Intravenous immunoglobulin and plasmapheresis alleviated the acute neuropathy and thrombocytopenia, while the bullous pemphigoid has been aggravated. In summary, the simultaneous occurrence of multiple autoimmune processes was a sign of a dysfunctional immune system preceding the relapse of a B-cell non-Hodgkin's lymphoma.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Cranial Nerve Diseases / complications
  • Cranial Nerve Diseases / immunology*
  • Cranial Nerve Diseases / therapy
  • G(M2) Ganglioside / immunology*
  • Humans
  • Immunoglobulin M / blood*
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunologic Factors / therapeutic use
  • Lymphoma, Large B-Cell, Diffuse / complications*
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Male
  • Paraproteins / metabolism*
  • Pemphigoid, Bullous / complications
  • Plasmapheresis
  • Polyradiculoneuropathy / complications
  • Polyradiculoneuropathy / immunology*
  • Polyradiculoneuropathy / therapy
  • Recurrence
  • Thrombocytopenia / complications

Substances

  • Immunoglobulin M
  • Immunoglobulins, Intravenous
  • Immunologic Factors
  • Paraproteins
  • G(M2) Ganglioside