Ann Neurol Surg | Volume 4, Issue 1 | Case Report | Open Access

Poems Syndrome without “M” - Could it be Possible? A Case Report

Emanuelle Bianchi da Silva Rocha^1*, Christina Covolo de Carvalho^², Rosana Herminia Scola³ and Paulo Eduardo Mestrinelli Carrilho⁴

¹Department of Neurology, Medical School of São José do Rio Preto (FAMERP), São José do Rio Preto, Brazil
²Department of Hematology, Oncology Center of Cascavel, Brazil
³Department of General Practice, Neurology Unit, Federal University of Parana, Brazil
⁴Department of Neurology, State University of Western Parana (UNIOESTE), Brazil

^*Correspondance to: Emanuelle Bianchi da Silva Rocha 

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Abstract

Introduction: POEMS syndrome is a rare disease characterized by polyneuropathy, organomegaly, endocrinopathy, “M-protein” disorder and skin changes. The purpose of this article is to report a case of a patient with progressive polyneuropathy without M protein and plasma cells disorder, one of the mandatory criteria diagnoses. Case: A 43 year-old man of Japanese origin with three months of weight loss, painful feet paresthesias and reduction of muscle strength in the lower limbs. At physical examination he presented distal motor deficit in legs, global absence of profound reflexes, feet amyotrophy, hepatosplenomegaly, gynecomastia, papilledema, axilar lymph node enlargement and a cyanosis of extremities. Myelogram and bone marrow biopsy discarded myeloma or plasma cell neoplasm. Protein electrophoresis and immune fixation electrophoresis not detected “M-spike”. After a clinical worsening, new diagnosis investigation was made and a vascular endothelial growth factor dosage was available (2812 pg/ml - normal range: 31 pg/mL to 86 pg/mL). Discussion: Polyneuropathy and plasma cells disorder are both mandatory diagnosis criteria for POEMS syndrome. However, we present a case without plasma cells disorder and “M-protein spike”, with the diagnosis confirmed with the combination of characteristic clinical manifestations and elevated vascular endothelial growth factor. We highlight that in some situations diagnose can be made with auxiliaries exams to avoid delay in starting treatment.

Keywords:

POEMS syndrome; Endocrinopathy; M-protien; Lymphadenopathy

Citation:

da Silva Rocha EB, de Carvalho CC, Scola RH, Mestrinelli Carrilho PE. Poems Syndrome without “M” - Could it be Possible? A Case Report. Ann Neurol Surg. 2020; 4(1): 1022..