When monoclonal gammopathy of undetermined significance is diagnosed, the patient is likely to have a variety of symptoms. The symptoms are variable, but most commonly include fever, rashes, lymphadenopathy, and a triad of abdominal pain, diarrhea, and fever. In some cases, the patient may also develop hepatitis. While there is no specific treatment for monoclonal gammopathy of unknown significance, it is best managed by a multidisciplinary team, which includes medical oncologists, hematologists, and primary care physicians. There are several complications associated with the disease, including hematochezia, thromboembolism, pulmonary fibrosis, and lymphadenopathy. Some of these complications may progress to myeloproliferative disorders if left untreated.
Pericarditis is a condition that can be caused by various infections. It is usually supportive, but can be constrictive, uremia-related, or metastatic. Pulmonary disease is the most common cause of pericarditis, but other causes can include hypothyroidism, pneumoniae, and breast disease. If the pericarditis is accompanied by an effusion, the result is called tamponade. Doppler examination of the heart can identify pressure gradients across the valves. An x-ray can identify bone abnormalities, as well as air-fluid levels. X-rays can also reveal osteolytic lesions. Other tests can help determine the etiology of pericarditis, such as an AFB smear.
Abdominal pain is often a symptom of a bacterial infection, but can occur with other conditions. Diagnosis of chronic sinusitis depends on history and physical exam. Typically, a sinusitis lasting more than 4 weeks is classified as chronic. However, subacute sinusitis is not considered to be chronic. Depending on the severity of the case, it may be treated with oral steroids and amoxicillin/clavulanate. Alternatively, general surgery may be required.
Various bacterial and fungal infections can cause pericarditis. Viral etiologies include rotavirus, coronavirus, and adenovirus. In addition, tricuspid valve endocarditis is rare, but can cause significant cardiac damage. Symptoms can include tachycardia, arrhythmia, and heart failure.
Other etiologies of esophagitis include peptic ulcer disease and biliary tract disease. Esophagitis can be acute or asymptotic. During the acute phase, it can be difficult to detect any symptoms. Nevertheless, an echocardiogram can identify focal ejection frac! and wall motion abnormalities. X-rays of the bowel can help determine the etiology, as can a colonoscopy. Surgical interventions can include ERCP or cholecystectomy. For choledocholithiasis, the stone may be removed with a cholecystectomy.
Tricuspid valve endocarditis is uncommon, but can be caused by various causes. It can be associated with embolic phenomena, carcinoid syndrome, and nontender macules on the soles of the feet. This is a potentially life-threatening condition that requires prompt medical attention. Because of the potential complications, it is best to treat it early, especially in the presence of underlying cardiovascular disease.
Monoclonal gammopathy of undetermined importance has the potential to progress to myeloproliferative diseases. As such, patients with this condition should be encouraged to rest, and if they are not responding to antibiotics, a referral to a hematologist is warranted. Currently, there is no cure for this condition, but research is underway to develop a more effective treatment.
