title: IgM-lambda paraproteinemia with associated cutaneous lymphoplasmacytic infiltrate in a patient who meets diagnostic criteria for POEMS syndrome.
abstract: 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.
authors.affiliation: School of Medicine, University of California at San Francisco, San Francisco, California 94143-0316, USA.
authors.forename: Shanthi M
authors.initials: SM
authors.lastname: Colaco
authors.forename: Tara
authors.initials: T
authors.lastname: Miller
authors.forename: Beth S
authors.initials: BS
authors.lastname: Ruben
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Fogarty
authors.forename: Lindy P
authors.initials: LP
authors.lastname: Fox
mesh_terms: 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
chemical_list: D007075:Immunoglobulin M; D007146:Immunoglobulin lambda-Chains