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Monoclonal Gammopathy Differential  -   Outlines in Clinical Medicine on Physicians' Online 2001

A. Inflammatory Disease        

  1. Epstein-Barr Virus Infection (EBV)
  2. Lymphadenitis See outline "Lymphadenopathy"
  3. Rheumatoid Arthritis See outline "Rheumatoid Arthritis"
  4. Other diseases with positive rheumatoid factor

B. Chronic Liver Disease

  1. Hepatitis C Virus
  2. Other Chronic Liver Disease

C. Hepatitis C Virus

1.  11% of patients with HCV had monoclonal gammopathies (MG) on SPEP
a.In this study, Genotype 2a/c was higher in patients with MG
b.In comparison, only 1% of patients with chronic liver disease (non-HCV or HBV) had MG

2.  Hepatitis C virus is the cause of most cases of essential mixed cryoglobulinemia
a.Type II Mixed Cryoglobulinemia
b.IgM usually monoclonal, with Rheumatoid Factor (anti-IgG) activity
c.Polyclonal immunoglobulins (Igs) also present
d.~90% of cases associated with Hepatitis C Virus, most often genotype 2a/III

D. Hematologic Neoplasia

  1. Multiple Myeloma
  2. Waldenstrom's Macroglobulinemia
  3. POEMS Syndrome
  4. B cell lymphomas (Non-Hodgkin Lymphomas)
  5. Benign lymphoproliferative disorders