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Background: We report the case of a monoclonal immunoglobulin of IgM Lambda isotype associated with monoclonal lambda-type free light chains not detected by capillary electrophoresis but identified by immunofixation., Methods: Capillary electrophoresis showed hypoproteinemia and an inflammatory syndrome. The IF realized on Hydrasys 2 Scan Focusing Sebia® reveals an IgM monoclonal band and two monoclonal bands in the total lambda. A second IF is performed using anti IgM, anti IgD, anti IgE and anti-total and -free lambda light chains as antisera. It reveals the presence of a monoclonal protein isotype IgM Lambda with free light chains. In view of these discordant results, an immunosubtraction was performed on the same sample showing no abnormality., Results: Our patient has a monoclonal IgM Lambda with lambda monoclonal free light chains all masked on capillary electrophoresis and therefore not detected., Conclusions: Capillary electrophoresis techniques are incrementally becoming the techniques of choice in medical laboratories as a replacement for gel electrophoresis, due to their automation and better sensitivity. However, in some cases, a monoclonal immunoglobulin may not be detected by capillary technique and may cause an inaccurate interpretation.

Eumycetomas are chronic subcutaneous pseudo-tumoral infections, endemic in arid tropical areas, which are caused by exogenous fungi that produce grains in vivo. The objective of our work is to establish their epidemiological, clinical and mycological profile in our Moroccan context. Therefore, we conducted a retrospective study, extending from 1975 to 2019, compiling all cases of eumycetomas that were diagnosed in the parasitology-mycology laboratory of the Ibn Sina University Hospital of Rabat. The diagnosis, based on the swabbing of exudates and eventual grains or the study of biopsies, included the direct examination of 30% KOH mounts, the realization of appositions colored by May-Grünwald-Giemsa and the incubation on 3 Sabouraud media at 27° and 37°C. In 44 years, 12 cases of eumycetoma have been diagnosed, with a male to female ratio of 5:1 and a mean age of 44.8 years. The lesions, evolving from 1 to 30 years, were podal in 10 cases, popliteal and gluteal in one case each, with osteolysis in 3 patients. The collected grains were black in 9 cases, white in 2 others. Direct examination was unanimously positive, revealing entangled hyphae, whilst culture isolated Madurella sp. in 9 cases, Trichophyton rubrum, Acremonium sp. in one case each and remained sterile in the last case. The treatment was medical in 8 cases, medico-surgical in 3 others, with loss of sight of most patients., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)