Age / Sex : 54 / M

Chief complaint: Right leg weakness, both hand numbness

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Quiz는 quiz일 뿐이오니 답안은 한 개만 보내주시기 바랍니다)

Courtesy: 김성준(Sungjun Kim), 강남세브란스병원(Gangnam Severance Hospital)

POEMS syndrome

Discussion

Findings:

1. Multiple sclerotic lesion of vertebral bodies and pelvic bone on CT images.

2. Focal FDG uptake at L1 vertebral body on PET scan.

3. Splenomegaly.

Differential Diagnosis:

Sclerotic variant of multiple myeloma, osteoblastic bone metastasis, osteopoikilosis, lymphoma.

Diagnosis:  

POEMS syndrome

Discussion:

POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes) syndrome is a rare paraneoplastic syndrome due to an underlying plasma cell disorder. It is first described by Bardwick in 1980. The pathogenesis is unknown. Recently proposed guideline for the diagnosis is like follows: three of the major criteria, two of which must include polyradiculoneuropathy and clonal PCD, and at least one of the minor criteria in the following features.

References:

 Dispenzieri A. Am J Hematol. 2014 Feb;89(2):214-23.