Biclonal gammopathay in a case of severe COVID-19

Abstract

COVID-19 is a disease caused by a coronavirus named as SARS-CoV-2. It has become pandemic due to its contagious nature. Majority of the patients are asymptomatic or having mild flu like symptoms. Few need hospitalisation due to severe acute respiratory infection (SARI). Co-morbidity like diabetes, hypertension, renal failure etc. are associated with severe COVID-19 that often causes death. There have been only two published case reports of monoclonal gammopathy of unknown significance (MGUS) in patients with COVID-19 disease. Cytokine storm is often observed in severe COVID-19 and various cytokines including IL-6 that activates plasma cells are increased in blood in this condition. Here we present a case of severe COVID-19 patient with bioclonal gammopathy. He was known diabetic and hypertensive on treatment. He developed SARI, cytokines storm and septicaemia, treated with antibiotics, enoxaparin, hydroxychloroquine, insulin, anti-hypertensives, put on ventilator, subsequently developed septicaemia, multi-organ failure and died. Two M-bands on serum capillary electrophoresis with presence IgG-κ on both the M-bands indicates a biclonal gammopathy of unknown significance in this patient. We conclude that like MGUS, early stage biclonal gammopathy, although rare, gets manifested with M-bands on plasma protein electrophoresis. It is probably due to high level of IL-6 associated with cytokine storm in severe COVID-19 that stimulate early stage dyscratic plasma cells. Such biclonal gammopathy might be a risk factor for COVID-19 and associated mortality.

Monoclonal Gammopathy in Korean COVID-19 Patients.

“…Alpha-1 bands were increased in most cases, and gamma bands showed either increased or decreased pattern (Supplementary Table S1). These findings are consistent with acute phase inflammation pattern with increased alpha globulin fraction, as seen in previous report [11].…”

“…The rise in antibody titer is associated with increased height or area under curve (AUC) of the gamma band, but the occurrence of monoclonal band is uncommon. However, recent publications reported that monoclonal bands can be detected by EP/IT tests in some COVID-19 infected patients [7][8][9][10][11], although longitudinal dynamics and characteristics of these monoclonal bands according to the clinical course have not been sufficiently discussed. In this study, we describe monoclonal patterns of serial serum protein EP/IT results in 9 Korean patients diagnosed with COVID-19 infection.…”

SARS‐CoV‐2 infection is not associated with the emergence of monoclonal gammopathies

“…Our study, including a large cohort of patients admitted to the hospital, suggests that there is no significant correlation between SARS‐CoV‐2 infection and MC development, contrary to what has been reported in several case reports 27–30 . Risk factors such as age and sex, which are known to be positively correlated with MGUS 31 do not appear to influence the development of a monoclonal spike following SARS‐CoV‐2 infection.…”

“…Our study, including a large cohort of patients admitted to the hospital, suggests that there is no significant correlation between SARS-CoV-2 infection and MC development, contrary to what has been reported in several case reports. [27][28][29][30] Risk factors such as age and sex, which are known to be positively correlated with MGUS 31 Note: No statistically significant differences were found for any parameters analyzed and compared between the two groups. Abbreviations: MC, monoclonal component; SD, standard deviation.…”

Coordination of N, O-donor Appended Schiff Base Ligand N, N’-bis (3-Methoxy Salicylidenimino-1,3-diaminopropane) towards Nickel (II), Copper (II) and Zinc (II) : Synthèses, Crystal Structure

“…"These ligands are widely used for the synthesis of complexes with very interesting biochemical and physical properties" [7][8][9][10]. "The formation of acyclic ligand complexes depends on the flexibility of the arms bearing the groups having donor sites, the nature of the donor atoms and the complexation properties of the cations and anions playing the role of charge balance" [11][12][13][14]. "These Schiff bases have made it possible to develop molecular materials with specific properties" [15][16][17][18][19].…”