title: Microvasculitic paraproteinaemic polyneuropathy and B-cell lymphoma.
abstract: Microvasculitis may play a greater part in the pathogenesis of paraproteinaemic neuropathies than is generally recognised, producing tissue destruction by convergent immune and physical mechanisms. We present a patient with a clinical syndrome of mononeuritis multiplex and a circulating IgM lambda paraprotein, in whom bone marrow aspiration revealed a lymphoplasmacytoid lymphoma. Microvasculitic changes were present in the first nerve biopsy, and the second showed extensive destruction of neural architecture and deposition of IgM-related material. A 2-stage pathogenic cascade is postulated and explored with a review of the relevant literature.
authors.affiliation: Department of Neurology, Institute of Psychiatry, King's College, De Crespigny Park, London SE5 8AF, UK. m.turner@iop.kcl.ac.uk
authors.forename: Martin R
authors.initials: MR
authors.lastname: Turner
authors.forename: Jason D
authors.initials: JD
authors.lastname: Warren
authors.forename: Jean M
authors.initials: JM
authors.lastname: Jacobs
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Groves
authors.forename: Kwee
authors.initials: K
authors.lastname: Yong
authors.forename: William P
authors.initials: WP
authors.lastname: Honan
authors.forename: P K
authors.initials: PK
authors.lastname: Thomas
authors.forename: Mary M
authors.initials: MM
authors.lastname: Reilly
mesh_terms: D000368:Aged; D017252:CD3 Complex / Q000378:metabolism; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D004727:Endothelium / Q000648:ultrastructure; D005205:Fascia; D006801:Humans; D007075:Immunoglobulin M / Q000378:metabolism; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000378:metabolism; D008297:Male; D008833:Microcirculation / Q000648:ultrastructure; D008854:Microscopy, Electron; D020422:Mononeuropathies / Q000209:etiology; D009431:Neural Conduction; D010265:Paraproteinemias / Q000150:complications* / Q000378:metabolism; D010266:Paraproteins / Q000378:metabolism; D011115:Polyneuropathies / Q000150:complications* / Q000378:metabolism; D012196:Review Literature as Topic; D014657:Vasculitis / Q000209:etiology*
chemical_list: D017252:CD3 Complex; C001437:IgM-L paraprotein; D007075:Immunoglobulin M; D010266:Paraproteins