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Case Reports
. 2022 Sep 4;22(1):406.
doi: 10.1186/s12876-022-02477-6.

Are we forgetting to carry out serum protein electrophoresis as part of diagnosis workup?

Mariana Barros Marcondes  1 , Cíntia Mitsue Pereira Susuki  1 , Newton Key Hokama  1 , Paula de Oliveira Montandon Hokama  1 , Felipe Aguera Oliver  2 , Paulo Sergio Chaib  3 , Xingshun Qi  4 , Fernando Gomes Romeiro  5
Affiliations
Case Reports

Are we forgetting to carry out serum protein electrophoresis as part of diagnosis workup?

Mariana Barros Marcondes et al. BMC Gastroenterol. .

Abstract

Background: Common variable immunodeficiency (CVID) is a rare disease that affects children and adults and is often difficult to diagnose. Despite being one of the most frequent causes of immunodeficiency, involving gastrointestinal (GI), respiratory, and hematological systems, the disease onset can have heterogeneous and intermittent symptoms, frequently leading to diagnostic delay. GI symptoms are common and can include diarrhea, but the asymptomatic periods lead to overlooking the recurrent pattern. The same can occur with respiratory infections, thus delaying CVID suspicion. The starting point for CVID diagnosis is the decreased gamma globulin levels in serum protein electrophoresis (SPE), also observed through direct immunoglobulin's dosage.

Case presentation: The patient is a 38 years-old man who had intermittent diarrhea and recurrent airway infections for 19 years, but the CVID diagnosis was achieved only after SPE was carried out. At that time, he was already malnourished, and developed other complications related to CVID in a short period.

Conclusions: SPE is readily available and inexpensive, but is not part of the laboratory approach in diarrhea. According to the case presented herein, it can be useful for patients with recurrent infections or other clues of the disease.

Keywords: Agammaglobulinemia; Case report; Common variable immunodeficiency; Diarrhea; Immunodeficiency; Serum protein electrophoresis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Chest computed tomography showing mucus hypersecretion (black arrows), thickening of the peri-bronchiolar walls (white arrowheads) and a “tree-in-bud” pattern reflecting bronchiolar mucoid impaction with additional involvement of adjacent alveoli (black arrowheads)
Fig. 2
Fig. 2
Serum protein electrophoresis. The numbers represent the electrophoretic run of different patients. When the sample is applied and the electric current is turned on, the serum proteins migrate differentially. Then, they are fixed and stained in blue. The most stained band is albumin, followed by alpha 1 globulin, alpha 2 globulin, beta globulin and gamma globulin. Column 6 shows a normal pattern of gamma globulin intensity and width. Column 7 is from the case reported, showing a marked reduction in the gamma globulin region. Column 8 was obtained from a patient with a monoclonal peak just after the beta globulin band and reduced gamma region. Column 3 displays a polyclonal gamma globulin augmentation (polyclonal hypergammaglobulinemia). After staining, the results are read by spectrometry to quantify each band
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