Hyperviscosity syndrome associated with an idiopathic monoclonal IgA-rheumatoid factor

Masaaki Kosaka, Alan Solomon

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

We report the clinical features and results of serologic studies of a patient with an idiopathic hyperviscosity syndrome whose serum contained large amounts of immunoglobulin-anti-immunoglobulin immune complexes. The intermediate-sedimenting (i.e., between 7S and 19S) nature of the circulating immune complexes was demonstrated by sucrose density gradient ultracentrifugation and gel filtration analyses. By analytic ultracentrifugation, the predominant peak of intermediate-sedimenting protein was calculated to be ~14S; no high molecular weight protein aggregates (>19S) were apparent even when undiluted serum was examined. The immunoglobulin with rheumatoid factor activity and the immunoglobulin-antiimmunoglobulin immune complexes were isolated and characterized. The rheumatoid factor activity was attributed to a monomeric, monoclonal 7S IgAk protein and its anti-immunoglobulin activity localized to the F(ab')2 fragment. The immune complexes consisted of the monoclonal immunoglobulin A (IgA) protein and polyclonal immunoglobulin G (IgG). The immune complexes were dissociable under acid conditions, and reconstitution experiments provided evidence for the intermediate-sedimenting and viscous nature of the monoclonal IgA-polyclonal IgG complexes. This patient had no evident features of a lymphocytic or plasma cell malignancy or of a disease state typically associated with the presence of rheumatoid factor. Treatment with plasmaphereses and cyclophosphamide reduced the serum concentrations of the monoclonal IgA protein and the IgA-IgG immune complexes; this response was associated with decreased serum viscosity and attendant clinical improvement.

Original languageEnglish (US)
Pages (from-to)145-154
Number of pages10
JournalThe American Journal of Medicine
Volume69
Issue number1
DOIs
StatePublished - Jan 1 1980

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Rheumatoid Factor
Antigen-Antibody Complex
Immunoglobulin A
Immunoglobulins
Immunoglobulin G
Ultracentrifugation
Serum
Proteins
Plasmapheresis
Plasma Cells
Viscosity
Cyclophosphamide
Gel Chromatography
Sucrose
Molecular Weight
Acids
Neoplasms

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Hyperviscosity syndrome associated with an idiopathic monoclonal IgA-rheumatoid factor. / Kosaka, Masaaki; Solomon, Alan.

In: The American Journal of Medicine, Vol. 69, No. 1, 01.01.1980, p. 145-154.

Research output: Contribution to journalArticle

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