Short communication IgA monoclonal gammopathy of undetermined significance with peripheral neuropathy M.M. Mehndiratta a, * , K. Sen a , M. Tatke b , B.K. Bajaj a a Department of Neurology, G.B. Pant Hospital, New Delhi 110002, India b Department of Pathology, G.B. Pant Hospital, New Delhi 110002, India Received 4 October 2002; received in revised form 14 October 2003; accepted 23 February 2004 Abstract Monoclonal gammopathy of undetermined significance (MGUS) and peripheral neuropathy may be causally linked. In most cases, the M- protein is of IgG or IgM type. Peripheral neuropathy associated with IgA MGUS is uncommon, and there are limited reports. Here, we report a case of a 55-year-old male who was diagnosed to have symmetrical sensorimotor peripheral neuropathy associated with IgA MGUS with deposits of IgA-monoclonal protein in the myelin sheath. D 2004 Elsevier B.V. All rights reserved. Keywords: Monoclonal gammopathy; Benign monoclonal gammopathy; Monoclonal gammopathy of undetermined significance (MGUS); Peripheral neuropathy 1. Introduction Polyneuropathies associated with monoclonal gammo- pathies are of interest because of potential relationship between the monoclonal protein and immune mediated nerve damage. Approximately 10% of patients with pe- ripheral neuropathy of otherwise unknown etiology have monoclonal gammopathy [1]. The prevalence of neurop- athy in patients with monoclonal gammopathy of unde- termined significance (MGUS) varies between 16% and 28% [2,3]. M-proteins are of three types: IgG (most common), IgM (second most common) and IgA (least common) [4]. Peripheral neuropathy occurs most com- monly with IgM-MGUS, and least commonly with IgA- MGUS. Much less is known about neuropathy associated with IgA-MGUS, and only few cases of this type have been reported [2,4,5]. Unlike IgM-MGUS, cases of IgG- MGUS and IgA-MGUS may have no reactivity to IgG or IgA M-proteins with nerve, and often deposits, of the M- protein are found in the myelin sheath [2]. We report a patient of IgA-MGUS with peripheral neuropathy that had deposits of IgA M-proteins on the myelin sheath, and this is probably the first case report from India. 2. Case report A 55-year-old male presented with insidious onset and slowly progressive cotton wool sensation in the feet of 4 months duration. One month later, he developed imbalance during walking which would worsen in the dark. Three months after the onset of the disease, his slippers began to slip during walking, and he also developed mild weakness of handgrip. The patient started having painful paraesthesias in the glove and stocking distribution. All the symptoms were symmetrical in onset. Severe burning pain in feet disturbed patient’s sleep. Subsequently, he developed tingling and needle-prick sensations in the lower limbs. There was no history of proximal weakness in upper or lower limbs, cranial nerve involvement, bladder, bowel dysfunction, fe- ver, anorexia, weight loss, rash, alopecia, joint pains, bony tenderness, hypertension, diabetes or history of drug intake. A general physical examination revealed normal vitals. There was no pallor, clubbing, cyanosis, icterus, lymphade- nopathy or pedal edema. There was no thyroid enlargement. Systemic examination was unremarkable. Central nervous system and cranial nerves examination was normal. Exam- 0022-510X/$ - see front matter D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.jns.2004.02.020 * Corresponding author. Tel./fax: +91-11-23234350. E-mail address: mmehndi@vsnl.com (M.M. Mehndiratta). www.elsevier.com/locate/jns Journal of the Neurological Sciences 221 (2004) 99 – 104