title: [Clinical judgment and decision making in medical practice. A retiree with fatigue and foot drop].
abstract: A 64-year-old former civil servant consulted his general practitioner because of severe fatigue. Later he began to lose weight and gradually developed chronic sensorimotor polyneuropathy characterized by sensory nerve loss which started in his legs. After a year he needed a wheel chair and developed cachexia. IgG paraprotein was detected. Morbid-anatomical examination of enlarged supraclavicular lymph nodes revealed plasma cell angiofollicular hyperplasia, characteristic of Castleman's disease. Treatment with corticosteroids led to marked improvement of the patient's condition. He was able to walk again, using an ankle orthosis on both legs.
authors.affiliation: Afd. Neurologie, Academisch Ziekenhuis, Utrecht.
authors.forename: N C
authors.initials: NC
authors.lastname: Notermans
authors.forename: H M
authors.initials: HM
authors.lastname: Lokhorst
authors.forename: R
authors.initials: R
authors.lastname: Wielaard
authors.forename: D H
authors.initials: DH
authors.lastname: Biesma
authors.forename: G J
authors.initials: GJ
authors.lastname: Rinkel
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D005871:Castleman Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003937:Diagnosis, Differential; D005221:Fatigue / Q000209:etiology*; D005528:Foot / Q000294:innervation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology*; D010257:Paraneoplastic Syndromes / Q000175:diagnosis; D010265:Paraproteinemias / Q000175:diagnosis; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis; D011241:Prednisone / Q000627:therapeutic use; D014806:Vitamin B 12 Deficiency / Q000175:diagnosis
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone