Thread by @KirtanPatolia

Not many entities in Medicine are as intricate as Paraproteinemias

As we celebrate National Internal medicine day today, here is a 🧵exploring its various associations and complications

#MedTwitter #hematology @AnnKumfer @RebeccaEBerger @Sharminzi @rabihmgeha @DxRxEdu @rav7ks

Entities that can feature a monoclonal protein/M component:

-MM
-WM
-MGUS
-MGCS
-MGRS
-Splenic Marginal Zone Lymphoma (HCV)
-CLL & MBL
-Heavy Chain disease (Gamma, Alpha & Mu)

There are various others indirectly associated with the M component. More to follow

Skin manifestations

-Scleromyxedema
-NXG
-Neutrophilic dermatosis
-Pyoderma gangrenosum
-Cutaneous macroglobulinosis
-POEMS: hypertrichosis, hyperpigmentation, hemangiomata, clubbing
-Clarkson/Systemic capillary leak syndrome
-Erythema elevatum et diutinium

#dermtwitter

Neurologic manifestations

-Hyperviscosity syndrome
-CVST
-Bing-Neel syndrome
-DADS-M
-POEMS (Sclerotic myeloma, lambda predominance)
-CANOMAD (Ataxia+neuropathy)
-Systemic late-onset nemaline myopathy
-Anti MAG neuropathy
-Scleromyxedema (Dermato-neuro syndrome)

#NeuroTwitter

Paraprotenemia & Autoimmunity #1

-MM/WM: Vasculitis (Cryoglobulinemic, Hypo/normo-complementemic urticarial, Schnitzler syndrome, Hypergammaglobulinemic macular Vasculitis)

Autoantibodies:
-WAIHA, CAD, PCH, Evans, ITP
-C1-NH: angioedema
-vWD & acquired F-X def (Coagulopathy)

Paraproteinemia & Autoimmunity #2

-SMZL: AIHA, Coombs (-) hemolytic anemia due to cold IgG, Lupus anticoagulant, IgM anti-cardiolipin, ITP. Sometimes associated with HCV

-Gamma heavy chain disease/Franklin disease- RA, AIHA, ITP, SLE, Sjogren's, Myasthenia gravis, Vasculitis

MGRS

-Fibrillar deposits: Amyloidosis
and monoclonal fibrillary GN
-Microtubular: Immunotactoid GN & Cryoglobulinemic GN
-Crystalline: light chain proximal tubulopathy/Fanconi, crystal-storing histiocytosis, and cryocrystalglobulin GN
-C3 GN
-Cast nephropathy
-TMA

#NephTwitter

Multi-system involvement

-POEMS (Sclerotic myeloma+⬆️VEGF+M component+neuropathy+Castleman+Organomegaly+⬆️RBC&Plt,+⬆️thrombosis+Pulm HTN+skin)
-Scleromyxedema (CNS+GI+CVS+joints)
-Amyloidosis (CVS+PNS+GI+Endocrine)
-TEMPI
-TAFRO

Miscellaneous

-Sneddon-Wilkinson disease (Subcorneal pustular dermatosis)
-Gleich syndrome (Episodic angiodema+eosinophilia)
-Pseudohyponatremia
-⬇️anion gap
-CRAB
-Hyperviscosity (Thrombosis in vascular beds-renal, retinal, DVT, CVST)

@CPSolvers @RosenelliEM @jackpenner