[Simultaneous presence of macroamylase and macrolipase in a patient with celiac disease].

Celiac disease is a permanent intolerance to ingested gluten that results in immunologically mediated inflammatory damage of the small intestinal mucosa. Here we report the case of a patient with Celiac disease demonstrating simultaneous macroamylasemia and macrolipasemia. The patient showed persistently elevated levels of serum amylase and lipase. Amylase and lipase in normal serum were eluted from a Superdex-200 column after the 4S protein. These enzymes in the serum from this patient were eluted in the 19S protein. This finding indicated that these enzymes from this patient had a molecular weight greater than that of normal amylase and lipase. Immunoprecipitation assay showed that amylase was bound to polyclonal IgG and IgA, whereas lipase was bound to polyclonal IgA. To our knowledge, the simultaneous presence of macroamylase and macrolipase in the same patient has been previously reported in only four cases. Interestingly, two of those patients had Celiac disease. If macroamylase and macrolipase are present, the possibility of Celiac disease should be considered.

[Immunochemical properties of free mu-chain protein in a patient with mu-heavy chain disease].

We report a case of mu-heavy chain disease. A 56-year-old woman presented with anemia and hemorrhagic diathesis. The serum of the patient was found to have free mu-heavy chain. The patient also had a kappa type-Bence Jones protein in serum and urine. Immunoelectrophoresis showed an abnormal precipitin line in the alpha 2-globulin region which reacted with antiserum to mu-chain but not with antiserum for light chains. The molecular weight of the monomer of the patient's mu-heavy chain protein was approximately 67,000 daltons less than that of the normal mu-heavy chain protein.

[A case with multiple myeloma in which serum forms gel precipitation upon exposure to air].

We present the case of a 69-years-old man who was admitted to hospital with multiple myeloma. IgG-kappa type monoclonal protein was detected in the serum. When we separated the serum obtained from blood sample of the patient and the lid of the collecting tube was opened, the patient's serum became gelled immediately. When the lid of the collecting tube remained closed, the patient's serum did not become gelled even at 4 degrees C. Moreover, the gelled serum of the patient did not resolve at 56 degrees C. Taken together, these results indicated that gel formation of the patient's serum may not be due to cryoglobulin. It was found that the pH of the patient's serum elevated to pH 8.0 quickly after exposed to air. It was also found that the patient's serum, but not the sera of other IgG-kappa multiple myeloma patients, became gelled as soon as PBS of pH 8.0 was added. These results highly suggest that the patient's serum becomes gelled at pH 8.0. However, the isoelectric focusing of isolated precipitation in the patient showed fractions around the pH 8.5-8.7 zone, which was different from the pH at which the precipitation began to form. We think that this may be the first report of a multiple myeloma patient whose serum becomes gelled after exposed to air.