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Expanding the spectrum of monoclonal light chain deposition disease in muscle
Author(s) -
Ostrow Lyle W.,
Corse Andrea M.,
Morrison Brett M.,
Huff Carol A.,
Carrino John A.,
Hoke Ahmet,
Mammen Andrew L.
Publication year - 2012
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.23287
Subject(s) - immunoglobulin light chain , medicine , pathology , muscle biopsy , myopathy , biopsy , angiopathy , plasma cell dyscrasia , monoclonal , amyloid (mycology) , amyloidosis , monoclonal antibody , antibody , immunology , endocrinology , diabetes mellitus
The diagnosis of amyloid myopathy is delayed when monoclonal gammopathies are not detected on initial testing and muscle biopsies are nondiagnostic, and the EMG and symptoms can mimic an inflammatory myopathy. Methods: Case report of a patient presenting with severe progressive muscle weakness of unclear etiology despite an extensive workup including two nondiagnostic muscle biopsies. Results: Directed by MRI, a third biopsy revealed amyloid angiopathy and noncongophilic kappa light chain deposition in scattered subsarcolemmal rings and perimysial regions. A serum free light chain (FLC) assay revealed a kappa monoclonal gammopathy, which was not detected by multiple immunofixations. Conclusions: The spectrum of immunoglobulin deposition in muscle is similar to other organs. It comprises a continuum that includes parenchymal amyloid deposition, amyloid angiopathy, and noncongophilic Light Chain Deposition Disease (LCDD). We recommend including the FLC assay in the routine investigation for monoclonal gammopathies. This case also highlights the value of MRI‐guided muscle biopsy. Muscle Nerve, 2012