Severe Enteropathy Caused By Alpha-Heavy Chain Disease Lacking Detectable M-Proteins

A 57-year-old Japanese man was admitted to our hospital with diarrhea, weight loss and malabsorption. Due to a high serum IgA level, we suspected alpha-heavy chain disease (alpha-HCD). However, no monoclonal IgA was detected on protein electrophoresis or immunofixation. Immunohistochemical staining of intestinal biopsy specimens showed proliferation of CD138(+)IgA(+) cells, compatible with a diagnosis of alpha-HCD. Most alpha-HCD patients exhibit M-proteins in the serum on electrophoresis or immunoelectrophoresis; however, some patients lack detectable M-proteins, similar to our patient. Therefore, when alpha-HCD is suspected based on the clinical features, immunohistochemistry is required to make a diagnosis.