title: [Bilateral phrenic nerve paralysis, dysautonomia and restrictive cardiomyopathy in a case of POEMS syndrome].
abstract: We report a case of POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M protein and Skin changes) with unusual clinical features. A 62-year-old woman presented a severe polyneuropathy with dysphonia and vegetative symptoms, including bradycardia and sphincterial disorders. The clinical examination showed facial hyperpigmentation, cachexia, anasarca and splenomegaly. She also presented restrictive cardiomyopathy and endocrine disturbances. Nerve conduction studies revealed a severe demyelinating sensorimotor neuropathy. Cerebrospinal fluid analysis showed an elevated protein level. We detected a biclonal gammapathy (Ig G and Ig A with lambda light chain) and lytic pelvic bone lesions. Later, she developed a severe ventilatory failure due to a bilateral phrenic nerve paralysis leading to a mechanical ventilation. Steroids followed by localized radiotherapy partially improved the respiratory status and stabilized the neuropathy. Phrenic nerve paralysis, restrictive cardiomyopathy, vegetative symptoms and cranial nerve palsy are exceptional in POEMS syndrome. Moreover, this case emphasizes the importance of radiological investigations since the discover of plasmocytoma may improve the prognosis of POEMS syndrome.
authors.affiliation: Service de neurologie D, Hôpital Roger Salengro, 59037 Lille.
authors.forename: S
authors.initials: S
authors.lastname: Delalande
authors.forename: T
authors.initials: T
authors.lastname: Stojkovic
authors.forename: C
authors.initials: C
authors.lastname: Rose
authors.forename: A
authors.initials: A
authors.lastname: Millaire
authors.forename: J F
authors.initials: JF
authors.lastname: Hurtevent
authors.forename: P
authors.initials: P
authors.lastname: Vermersch
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000473:pathology; D009202:Cardiomyopathies / Q000209:etiology*; D002556:Cerebrospinal Fluid Proteins / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000378:metabolism; D007075:Immunoglobulin M / Q000378:metabolism; D007146:Immunoglobulin lambda-Chains / Q000378:metabolism; D008875:Middle Aged; D009431:Neural Conduction / Q000502:physiology; D016878:POEMS Syndrome / Q000134:cerebrospinal fluid / Q000150:complications / Q000473:pathology*; D010243:Paralysis / Q000209:etiology*; D010384:Pelvic Bones / Q000473:pathology; D010791:Phrenic Nerve / Q000473:pathology*; D010954:Plasmacytoma / Q000473:pathology; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology; D013256:Steroids; D014057:Tomography, X-Ray Computed
chemical_list: D000893:Anti-Inflammatory Agents; D002556:Cerebrospinal Fluid Proteins; D007070:Immunoglobulin A; D007075:Immunoglobulin M; D007146:Immunoglobulin lambda-Chains; D013256:Steroids