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Guillaume Feugray, Jennifer Guillerme, Stéphanie Pramil, Marion Carrette, Muriel Quillard Muraine, An Unexpectedly High IgE Level during Allergic Exploration, Clinical Chemistry, Volume 71, Issue 2, February 2025, Pages 241–245, https://doi.org/10.1093/clinchem/hvae151
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Case Description
A 78-year-old man presented to the hospital with hemoptysis. The patient’s medical history included active smoking, dyslipidemia, diabetes, and hypertension. A thoracic scan revealed pulmonary emphysema associated with bronchial dilatation and diffuse bronchial thickening. Some calcified micronodules were observed, with a 5.2 mm posterobasal nodule in the right lobe. Based on these findings, a diagnosis of allergic bronchopulmonary aspergillosis (ABPA) was suspected. Laboratory tests revealed an extremely high level of total immunoglobin E (IgE), with a titer of >5000 kU/L [reference value (RV) < 114 kU/L for an adult] and anti-Aspergillus fumigatus-specific IgE of 0.2 kU/L (RV < 0.1 kU/L) (Phadia250®, Thermo Fisher). Aspergillus serology was negative and the diagnosis of ABPA was excluded. Complete blood count was normal except for lymphopenia (1.12 × 109/L) and thrombocytopenia (136 × 109/L). Results were also normal for renal and hepatic blood parameters (Cobas®8000, Roche) (Table 1).
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Systematic serum protein electrophoresis (SPE) (Capillarys2®, Sebia) found highly suspicious anomalies in the gamma-globulin fraction (Fig. 1A). Given this result, we performed serum immunofixation (IF) (Hydrasys®, Sebia) with 5 antisera [anti-immunoglobin G (IgG), A, M, total kappa, and lambda]. Due to the presence of an isolated lambda monoclonal band, we analyzed anti-immunoglobin D, anti-IgE, and anti-free light chains. IF revealed a wide IgEλ band in addition to a clonal IgGλ band (Fig. 1B-D), estimated at 4.3 g/L and 1 g/L, respectively, on SPE densitometry scan, with barely detectable lambda monoclonal free light chains. Reduction of the sample with beta-mercaptoethanol led to a more focused ε-band that aligned with the lambda band, suggesting monoclonality (Fig. 1D).
