# Polyclonal Hypergammaglobulinemia Associated With Multimorbidity and Malnutrition in an Elderly Man: A Comprehensive Diagnostic Approach

## TL;DR

An elderly man with multiple health issues and malnutrition showed signs of a blood disorder but was found to have a non-cancerous condition, highlighting the need for thorough diagnosis in complex cases.

## Contribution

The paper presents a case emphasizing the importance of considering non-malignant causes of hypergammaglobulinemia in elderly patients with multimorbidity.

## Key findings

- Polyclonal hypergammaglobulinemia was identified instead of multiple myeloma through comprehensive testing.
- Multimorbidity and malnutrition were found to contribute to chronic systemic inflammation and weight loss.
- A holistic management approach improved the patient's condition and preserved daily function.

## Abstract

A 76-year-old man with a history of liver cirrhosis, chronic obstructive pulmonary disease (COPD), secondary adrenal insufficiency, and psychiatric comorbidities presented with severe weight loss and laboratory findings of pancytopenia, hypoalbuminemia, and IgG-predominant hypergammaglobulinemia, raising suspicion for multiple myeloma. However, serum protein electrophoresis, immunofixation, and urinary Bence Jones testing showed no monoclonal protein, and the kappa/lambda (κ/λ) ratio remained normal, indicating polyclonal hypergammaglobulinemia. Further evaluation revealed decompensated liver cirrhosis with hypersplenism, secondary adrenal insufficiency, severe obstructive ventilatory defect from COPD, and nutritional deficiencies. Management included nutritional supplementation, infection control, diuretics, hydrocortisone replacement, and branched-chain amino acids, leading to gradual improvement and discharge with preserved daily function. This case illustrates how multimorbidity, malnutrition, and disuse can mimic malignant conditions, producing hypergammaglobulinemia and weight loss through chronic systemic inflammation. It emphasizes the importance of considering non-malignant causes, especially in frail older patients, and highlights the need for a comprehensive diagnostic and management approach that integrates chronic disease care, nutritional support, and community-based interprofessional collaboration.