Differential Diagnosis
- Single most likely diagnosis
- Chronic inflammatory disease (e.g., rheumatoid arthritis, chronic infections): This is the most likely diagnosis due to the polyclonal increase in gamma region, which is a common response to chronic inflammation. The borderline increase in beta globulin and elevated kappa and lambda free light chains (FLC) also support this diagnosis, as they can be seen in chronic inflammatory conditions.
- Other Likely diagnoses
- Chronic liver disease: Liver disease can cause a polyclonal increase in gamma globulins due to impaired protein synthesis and clearance. The elevated FLC levels can also be seen in liver disease.
- Chronic infections (e.g., HIV, hepatitis): Chronic infections can stimulate a polyclonal immune response, leading to an increase in gamma globulins and FLC levels.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Multiple myeloma: Although the IFE shows a normal pattern, which makes multiple myeloma less likely, it is essential to consider this diagnosis due to the elevated FLC levels. Multiple myeloma can present with a variety of laboratory abnormalities, and missing this diagnosis could have severe consequences.
- Lymphoma: Lymphoma can cause a polyclonal increase in gamma globulins and elevated FLC levels. Although the IFE is normal, lymphoma should be considered as a potential diagnosis.
- Rare diagnoses
- Amyloidosis: Amyloidosis can cause an increase in FLC levels, and although it is a rare condition, it should be considered in the differential diagnosis.
- Heavy chain disease: This is a rare condition characterized by the production of abnormal heavy chains, which can cause an increase in FLC levels. Although it is unlikely, it should be considered in the differential diagnosis due to the elevated FLC levels.