IgM-lambda paraproteinemia with associated cutaneous lymphoplasmacytic infiltrate in a patient who meets diagnostic criteria for POEMS syndrome.
POEMS is a rare multisystem paraneoplastic syndrome featuring polyneuropathy, organomegaly, endocrinopathy, a monoclonal protein, and skin changes. In the relatively few reported biopsies of POEMS-associated cutaneous hyperpigmentation, the most common skin finding seen in patients with the disorder, only a non-specific inflammatory infiltrate has been demonstrated histologically. We present the case of a 79-year-old man with polyneuropathy, autoimmune thyroiditis, pancytopenia, and a history of lymphadenopathy who presented to the inpatient dermatology service with cutaneous hyperpigmentation. A skin biopsy of a hyperpigmented area showed a cutaneous lymphoplasmacytic infiltrate, prompting further investigation. A monoclonal IgM-lambda paraprotein was subsequently identified, leading to administration of combination chemotherapy for a diagnosis of POEMS syndrome. The novel finding of a lymphoplasmacytic infiltrate in POEMS-associated hyperpigmentation suggests a diagnostic role for skin biopsy in these patients.
Colaco
Shanthi M
SM
School of Medicine, University of California at San Francisco, San Francisco, California 94143-0316, USA.
Miller
Tara
T
Ruben
Beth S
BS
Fogarty
Patrick F
PF
Fox
Lindy P
LP
D000368:Aged; D006801:Humans; D017495:Hyperpigmentation / Q000473:pathology*; D007075:Immunoglobulin M / Q000097:blood*; D007146:Immunoglobulin lambda-Chains / Q000097:blood*; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D016878:POEMS Syndrome / Q000473:pathology*; D010265:Paraproteinemias / Q000097:blood* / Q000473:pathology*; D010950:Plasma Cells / Q000473:pathology
D007075:Immunoglobulin M; D007146:Immunoglobulin lambda-Chains