[Aussie]

Fatty liver with IgM MGUS - sign of disease progression?

by Aussie on Sun Dec 10, 2017 12:52 am

Goodday

I have just completed my bi-annual blood tests for IgM MGUS and the results are in. Normally I would just assume changes in my results, like cholesterol to be a result of getting older. But with MGUS I am always worried that any new developments may be linked to my MGUS or may even be a result of MGUS.

So the latest tests show 44 AST and 75 ALT. Did a liver scan and looked like a mild fatty liver. Do not drink, weight is good but can improve on healthy eating and exercise, so it was a bit of a surprise. Understand ALT show inflammation of the liver and also understand the IGM protein is also to do with inflammation.

I am now worried this forms part of organ damages, I.e. CRAB requirements.

Yes, I have developed into a mild hypochondriac and so I like to be prepared when I see my doctors. So am I just paranoid or should I ask more questions? The doctor is not too worried and has requested more test (copper etc), but I am always worried they overlook things (human after all).

[Weber]

Re: Fatty liver with IgM MGUS - sign of disease progression?

by Weber on Fri Jan 05, 2018 12:17 am

I was diagnosed with IgM MGUS this past July when I presented with a very large liver. It was twice the normal size. The liver specialist ran a myriad of tests, including the immunoglobulin blood tests. The IgM came back in the upper 400's, which prompted a visit to a hematologist-oncologist, who re-tested and then did a bone marrow biopsy. We are monitoring every 3 months. I've also wondered how the liver enlargement is tied to the IgM MGUS. I have non­alcoholic fatty liver disease (NAFLD) and non­alcoholic steato­hepatitis (NASH), both found via liver biopsy.

I'm also experiencing neuropathy in my feet, which is increasing, and pain in joints (shoulders, knees, and in the muscles in my legs).

After my family practitioner heard of the symptoms involving my legs and neuropathy, he ordered an MRI of my back, which indicated severe disc height loss. An appointment was made with a neuro­surgeon, who believes all of the symptoms are related, but wasn't sure what was happening. I have an upcoming appointment with neurology and see my hematologist-oncologist next week. Yikes!

I know what you mean. You start feeling like a hypochondriac after while, yet all the symptoms are very real.

[lwem]

Re: Fatty liver with IgM MGUS - sign of disease progression?

by lwem on Fri Jan 05, 2018 9:21 am

I too have questions about fatty liver and whether myeloma-related amyloidosis could cause this. Just a question you might want to ask your hematologist.

[Multibilly]

Re: Fatty liver with IgM MGUS - sign of disease progression?

by Multibilly on Fri Jan 05, 2018 9:25 am

Has your doctor also ruled out amyloidosis (which can cause an enlarged liver and elevated liver enzymes)? Note this excerpt from the article referenced below:

"Association with AL amyloid – This complex disease can be associated with any form of myeloma, although usually one of the two processes dominates the clinical picture. That is to say that patients typically have either a myeloma-phenotype manifested by some combination of hypercalcemia, renal insufficiency, anemia, and skeletal involvement or an amyloid phenotype characterized by organ (liver, heart, kidney) infiltration by the pathologic immunoglobulin light chain. AL amyloid is more commonly associated with IgM-MGUS than other forms of MGUS. Thus, it is imperative that AL amyloid be carefully considered when evaluating patients with an IgM monoclonal protein."

Reference:

J Mikhael, "Ask the Hematologist: A Diagnostic Approach to Patients with an IgM monoclonal protein", The Hematologist, Sep 15, 2014 (full text of article)