Neuropathy accompanying IgM lambda monoclonal gammopathy.

A set of observations made on a patient with IgM lambda monoclonal gammopathy and neuropathy implicate humoral immunity in the pathogenesis of the neuropathy. A sural nerve biopsy from the patient showed a characteristic increase in the width of the intraperiod lines. Deposits of mu-heavy chains and lambda-light chains were found in myelin sheaths of the nerve biopsy. Immunohistochemically, it was demonstrated that mu-heavy chains and lambda-light chains from the patient's serum bound to myelin sheaths of normal peripheral nerves and to a lesser extent to myelin sheaths in the central nervous system (CNS). By immunoblots it was demonstrated that mu-heavy chains and lambda-light chains from the patient's serum bound to myelin associated glycoprotein but to no other antigens from the peripheral and central nervous systems. gamma and alpha heavy chains and chi light chains from the patient's serum were also shown to bind to myelin-associated glycoprotein but not as distinctly as the mu and lambda chains. It is postulated that the monoclonal gammopathy may have arisen on the background of polyclonal autoimmune attack directed against myelin-associated glycoprotein.