Case 4: A 76-year-old woman presented with a 6-month history of weakness, malais

Question

Case 4: A 76-year-old woman presented with a 6-month history of weakness, malaise, exertional dyspnea and abdominal discomfort. In the previous month she had experienced two dizzy spells but did not have headaches, visual disturbances, weight loss, bone pain or recurrent infections. On examination she was pale, with moderate axillary and cervical lymphadenopathy. Her liver and spleen were enlarged by 5cm.

Test

Patient

Reference

Test

Patient

Reference

Hemoglobin

10.8 g/dL

Serum Protein

13.0 g/dL

WBC

8.2/uL

IFE

IgM, kappa

Differential

Normal

IgG

.94 mg/dL

ESR

112 mm/h

IgA

.11 mg/dL

IgM

6.45 mg/dL

IgM paraprotein (M band)

6.3 mg/dL

Electrophoresis of concentrated urine showed no free monoclonal light chains and there were no bone lesions on X-rays of her chest and skull. Her serum viscosity, relative to water, was 4.7 (NR 1.4-1.8). A bone marrow examination showed a pleomorphic cellular infiltrate composed of a mixture of small lymphocytes, plasma cells and cells of an intermediate appearance, called lymphoplasmacytoid cells.

1.From the above data, what disease should the doctor suspect?

2.Why did the urine show no free monoclonal light chains?

3.Why does the patient show Axillary and cervical lymphadenopathy?

4.Why were X-rays done of her chest and skull?

5.What is the prognosis for this disease?

please explain the questions on the bottom i dont understand them

Test

Patient

Reference

Test

Patient

Reference

Hemoglobin

10.8 g/dL

Serum Protein

13.0 g/dL

WBC

8.2/uL

IFE

IgM, kappa

Differential

Normal

IgG

.94 mg/dL

ESR

112 mm/h

IgA

.11 mg/dL

IgM

6.45 mg/dL

IgM paraprotein (M band)

6.3 mg/dL

Explanation / Answer

1) From above data doctor can sugess may the sympotoms of Scarcoidosis

2)  The monoclonal light chains may be present in large enough amounts to also be quantitated as an M-spike on protein electrophoresis. The electrophoretic M-spike is the recommended method of monitoring monoclonal gammopathies such as multiple myeloma. Monitoring the urine M-spike is especially useful in patients with light-chain multiple myeloma in whom the serum M-spike is very small or absent, but the urine M-spike is large.

3) the site of infection can suggest the localized lymphadenopaths.

4) The chest and skull were x-ray it is an evidence of tuberculosis of 50%. General lymph is normal and axillary cerivical region up to 1cm

5) Prognosis is a prediction of the course of a disease following its onset. It refers to the possible outcomes of a disease and the frequency with which they can be expected to occur. Sometimes the characteristics of a particular patient can be used to more accurately predict that patient's eventual outcome.

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