• Information
  1. Inflammatory Disease
  2. Chronic Liver Disease
  3. Hepatitis C Virus
  4. Hematologic Neoplasia

A. Inflammatory Disease

1. Epstein-Barr Virus Infection (EBV)
2. Lymphadenitis
3. Rheumatoid Arthritis
4. Other diseases with positive rheumatoid factor [1]

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 [2]
   1. In this study, Genotype 2a/c was higher in patients with MG
   2. 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 [3]
   1. Type II Mixed Cryoglobulinemia
   2. IgM usually monoclonal, with Rheumatoid Factor (anti-IgG) activity
   3. Polyclonal immunoglobulins (Igs) also present
   4. ~90% of cases associated with Hepatitis C Virus, most often genotype 2a/III [4]

D. Hematologic Neoplasia

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

References

1. Condemi J. 1992. JAMA. 268(20):2882
2. Andreone P, Zignego AL, Cursaro C, et al. 1998. Ann Intern Med. 129(4):295
3. Zignego AL, Ferri C, Giannini C, et al. 1996. Ann Intern Med. 124(1):31
4. Misiani R, Bellavita P, Fenili D, et al. 1992. Ann Intern Med. 117:573