Polyneuropathy: a poetic diagnosis.

Abstract

A 60-year-old woman presented with subacute progressive lower extremity weakness. This was associated with a 40lb weight loss and fevers. She was previously healthy, aside from renal transplantation 9 years earlier for end stage renal disease resulting from IgA nephropathy. On examination, she had clubbing, a single lymph node in the right cervical chain, and objective findings of lower extremity weakness with lower motor neuron findings. Investigations revealed a thrombocytosis and elevated CSF protein. Electromyographic evidence of diffuse polyradiculopathy with demyelination was documented. On imaging, she had a large lytic/sclerotic lesion in the right scapula measuring 8 cm, a pericardial effusion, and borderline splenomegaly. Pathological assessment of the excised lymph node revealed Castleman-like changes; biopsy of the right scapular lesion revealed λ-restricted plasma cells, in the absence of a monoclonal protein in the bone marrow or periphery. A diagnosis of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) with plasmacytoma was established; a post-transplant lymphoproliferative disorder was suspected.

• Authors: Reena Pattani, Dmitry Rozenberg, Lee Mozessohn, Lisa Hicks
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2012 (Jul 10 2012) ISSN: 1757-790X [Electronic] England
• PMID: 22783007 (Publication Type: Case Reports, Journal Article)

Topics

• Biopsy
• Diagnosis, Differential
• Electromyography
• Female
• Humans
• Lymph Nodes (pathology)
• Middle Aged
• POEMS Syndrome (diagnosis)
• Tomography, X-Ray Computed