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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1740.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Acquired HDL Deficiency Associated With Apolipoprotein A-I Reactive Monoclonal Immunoglobulins

Armando J. Mendez; Ronald B. Goldberg; Patricia I. Arnold; Duane R. Schultz

Department of Medicine, University of Miami School of Medicine, Florida

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

Immunoglobulins (Igs) directed at components of lipoproteins to cause altered lipoprotein metabolism have been described in patients with multiple myeloma,^1,2 xanthomatosis,³ benign gammopathies,⁴ rheumatoid arthritis,⁵ systemic lupus erythematosus (SLE), and primary antiphospholipid syndrome (APS).^6,7 In most cases, hyperlipidemia results from Igs reactive with apolipoprotein (apo) B present on very low–density lipoproteins and LDLs. Less common have been associations of Igs with hypolipidemia or reactive with HDLs. Here we describe two patients who developed low HDL-cholesterol (HDL-C) levels (<5th percentile) associated with benign gammopathy and the presence of serum Igs reactive with apo A-I.

Patient 1 (P1) was a morbidly obese (body mass index, 48 kg/m2), 45-year-old woman with mild normocytic, normochromic anemia (hematocrit, 33 g/L; hemoglobin, 11.6 g/L) and low HDL-C (0.22 mmol/L [8 mg/dL]). Serum Ig levels were elevated. Antinuclear antibodies were detected but were nonreactive with dsDNA, Sm, RNP, SSA, SSB, SCL-70, and histone. Anticardiolipin and anti–ß2-glycoprotein I antibodies were negative. Immunofixation electrophoresis (IFE) identified monoclonal IgG and IgG bands. No Igs or light chains were detected in her urine.

Serum lipid levels showed that HDL-C was in the low-normal to normal range between 1992 and 1996 (1.0 to 1.4 mmol/L) but at the time of presentation (November 1999), HDL was markedly reduced (0.22 mmol/L). Concomitantly, there was an increase in serum triglyceride (from <1.3 to >2.5 mmol/L) and a decrease in LDL-C levels (from >3.8 to <2.2 mmol/L). Clinical features were fatigue and the development of asthma. In July 2000, a right perinephric mass was identified as . . . [Full Text of this Article]

This article has been cited by other articles:

				J. A. Schifferli, R. B. Goldberg, A. J. Mendez, and M. R. Murali Case 40-2006: Anemia and Low HDL Cholesterol N. Engl. J. Med., May 3, 2007; 356(18): 1893 - 1895. [Full Text] [PDF]