A Case of Combined POEMS Syndrome and Multiple Myeloma with Positive M protein Only on Immunofixation

Jae Hoon Yang; Joo Young Jung; Chan-Soo So; Yu Jin Lim; Seung-Yong Han; Sarah Park; Jung Han Kim; Mina Hur; Gyung Kyu Lee; Jung-Weon Shim; Young Iee Park

doi:10.5045/kjh.2008.43.4.253

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Yang, Jung, So, Lim, Han, Park, Kim, Hur, Lee, Shim, and Park: A Case of Combined POEMS Syndrome and Multiple Myeloma with Positive M protein Only on Immunofixation

Case Report

Korean J Hematol 2008;43(4):253-257.

Published online: 19 January 2008

DOI: https://doi.org/10.5045/kjh.2008.43.4.253

A Case of Combined POEMS Syndrome and Multiple Myeloma with Positive M protein Only on Immunofixation

Jae Hoon Yang¹, Joo Young Jung^1,, Chan-Soo So¹, Yu Jin Lim¹, Seung-Yong Han¹, Sarah Park¹, Jung Han Kim², Mina Hur³, Gyung Kyu Lee⁴, Jung-Weon Shim⁵, Young Iee Park⁶

¹Division of Internal Medicine, Hangang Sacred Heart Hospital, Seoul, Korea

²GangNam Sacred-heart Hospital, Seoul, Korea

³Division of Laboratory Medicine, Seoul, Korea

⁴Division of Radiology, Seoul, Korea

⁵Division of Pathology, Hangang Sacred Heart Hospital, Seoul, Korea

⁶Divison of Internal Medicine, National Medical Center, Seoul, Korea

Correspondence to：Joo Young Jung Division of Internal Medicine, Hangang Sacred Heart Hospital 94-200, 7ga, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul Tel: +82-2-2639-5400, Fax: +82-2-2677-9756 E-mail: jyj822@hanmail.net

Received 23 June 2008 Revised 27 October 2008 Accepted 1 November 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

POEMS syndrome is a plasma cell proliferative disorder is characterized by the presence of peripheral neuropathy (P), organomegaly (O), monoclonal gammopathy (M), endocrinopathy or edema (E) and skin change (S). It can be rarely related to multiple myeloma. A 48-year-old man was admitted to our hospital due to paresthesia of both inguinal areas and weakness of both lower extremities. He had a history of Castleman's disease, and showed features of polyneuropathy, multiple osteoblastic lesions, hepatosplenomegaly, pretibial pitting edema, and papilledema. The serum and urine electrophoresis were negative, but urine immunofixagion could detect monoclonal protein. Plasmacytoma was confirmed through the biopsy for the osteoblastic lesions. We present a case of combined POEMS syndrome and multiple myeloma with positive M protein only on immunofixation in order to share our experience with physicians and specialists.

Keywords: POEMS syndrome, Multiple myeloma, Osteoblastic lesion

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Fig. 1

Pelvic MRI showed multifocal osteoblastic lesions at pelvic bone, sacrum, and L5 (white arrows).

Fig. 2

Eccentrically placed nuclei of neoplastic plasma cells with basophilic cytoplasm and a sequestrum (black arrow) (Bone biopsy, H&E stain, ×400, A) and positive staining for λ chain (×400, B).

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