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Utility of osteosclerotic lesion biopsy in diagnosis of POEMS syndrome: A case report.
- Source :
-
Medicine [Medicine (Baltimore)] 2017 Oct; Vol. 96 (41), pp. e8188. - Publication Year :
- 2017
-
Abstract
- Rationale: We report a case of successful diagnosis of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome based on monoclonality that was confirmed by an osteosclerotic lesion biopsy in a patient without pathognomonic symptoms or monoclonal gammopathy, probably because of comorbidities, which included systemic lupus erythematosus, rheumatoid arthritis, and Sjögren syndrome.<br />Patient Concerns: A 57-year-old woman presented with an approximately 2-year history of numbness in the toes that had gradually spread, along with muscle weakness in both arms and legs. She had been receiving immunosuppressant and corticosteroid therapy since being diagnosed with systemic lupus erythematosus and Sjögren syndrome at the age of 31 years and rheumatoid arthritis at the age of 44 years. Neurological examination revealed predominantly distal hypoesthesia and weakness in a typical stocking-and-glove pattern. Immunoelectrophoresis revealed elevated polyclonal immunoglobulin, which was attributed to her known underlying disease.<br />Diagnoses: Biopsy of an osteosclerotic lesion confirmed proliferation of monoclonal plasma cells, leading to a diagnosis of POEMS syndrome.<br />Interventions and Outcomes: Lenalidomide therapy was started after the diagnosis and the patient had a favorable outcome.<br />Lessons: Osteosclerotic lesion biopsy can be useful for diagnosis of POEMS syndrome in difficult cases.
- Subjects :
- Arthritis, Rheumatoid complications
Arthritis, Rheumatoid drug therapy
Cell Proliferation
Diagnosis, Differential
Female
Humans
Immunoelectrophoresis methods
Immunologic Factors administration & dosage
Lenalidomide
Lupus Erythematosus, Systemic complications
Lupus Erythematosus, Systemic drug therapy
Middle Aged
Neurologic Examination methods
Sjogren's Syndrome complications
Sjogren's Syndrome drug therapy
Thalidomide administration & dosage
Treatment Outcome
Osteosclerosis diagnostic imaging
Osteosclerosis pathology
POEMS Syndrome diagnosis
POEMS Syndrome drug therapy
POEMS Syndrome physiopathology
Plasma Cells immunology
Plasma Cells pathology
Thalidomide analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 1536-5964
- Volume :
- 96
- Issue :
- 41
- Database :
- MEDLINE
- Journal :
- Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 29019884
- Full Text :
- https://doi.org/10.1097/MD.0000000000008188