26 April 2023: Articles
Rare Case of Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome with Monoclonal Gammopathy of Undetermined Significance
Challenging differential diagnosis, Rare disease
Alpana Garg E , Alexander A. Garza E* , Sachin Goyal E , Petar Lenert FDOI: 10.12659/AJCR.939650
Am J Case Rep 2023; 24:e939650
Table 1. Laboratory and investigation results.
| Test | Reference range with units | Result |
|---|---|---|
| Hemoglobin | 13.2–17.7 g/dL | 15.6 |
| Platelets | 150–400 K/mm3 | 230 |
| White blood count | 3.7–10.5 K/mm3 | 9.7 |
| Blood urea nitrogen | 10–20 mg/dL | 16 |
| Creatinine | 0.6–1.2 mg/dL | 0.9 |
| Alkaline phosphatase | 40–129 U/L | 56 |
| Alanine aminotransferase | 0–41U/L | 41 |
| Aspartate aminotransferase | 0–40 U/L | 45 |
| Lactate dehydrogenase | 125–225 U/L | 264 |
| Ferritin | 62 | |
| Uric acid | 3.4–7.0 mg/dL | 8.0 |
| Rheumatoid factor | 11 | |
| Anti-nuclear antibodies | ||
| Anti-neutrophil cytoplasmic antibody (ANCA) | Negative | |
| C2 complement | 1.6–4.0 mg/dL | 3.4 |
| C3 complement | 90–180 mg/dL | 106 |
| C4 complement | 16–47 mg/dL | 25 |
| Anti-cyclic citrullinated peptide antibody | ||
| Cryoglobulins | Negative | |
| Beta-2 microglobulin | 1.1–2.4 mg/L | 7.4 |
| Immunoglobulins | ||
| IgA | 70–400 mg/dL | 127 |
| IgG | 700–1600 mg/dL | 756 |
| IgM | 40–230 mg/dL | 101 |
| Erythrocyte sedimentation rateC-reactive protein | 0–15 mm/h | 100.7 |
| Hepatitis A (antibody) and hepatitis B (surface antigen and core antibody) | Negative | |
| Hemoglobin A1c | 4.8–6.0% | 5.5% |
| Serum blood glucose | 65–139 mg/dL | 108 |
| Thyroid function test | Normal | |
| Serum protein electrophoresis | Monoclonal protein present in gamma region comprising 0.1 gm/dL of total proteinIgG Kappa immunoglobulin | |
| Two-dimensional transthoracic echocardiogram | Ejection fraction 55–60%, normal ventricular size, normal right ventricular function | |
| X-ray of both hands and feet | No joint erosions | |
| Upper Extremity arterial and venous duplex (bilateral) | Normal | |
| Chest X-ray | Normal | |
| Computed tomography of the chest, abdomen, pelvis with contrast | Mild splenomegaly (14.4 cm) No suspicious lymphadenopathy Patent inferior vena cava and its major tributaries with no evidence of extrinsic compression or thrombosis | |
| Ultrasound of scrotum and testicles | Normal | |
| Bone marrow biopsy | 2–3% plasma cells | |
| Flow cytometry | 0.02% monotopic Kappa cells | |
| Cytogenetic analysis | Normal (46 XY) | |
| Fluorescence in situ hybridization (FISH) | Polysomy: including trisomy 5, 9, and 15 (10%)Monosomy 13 (10%) | |