Complementary examsThrombocytosis, basic biochemistry, and normal serologies. Cerebrospinal fluid tests showed increased protein content. Electroneuromyography revealed sensorimotor polyneuropathy with a demyelinating pattern and less axonal loss. Computed tomography revealed lymphadenopathy in several chains, and many sclerotic bone lesions. A bone marrow biopsy contained 10% of plasma cells. Protein electrophoresis of the urine showed a lambda monoclonal peak. The vascular endothelial growth factor (VEGF) was 300 times higher than the reference value.
Discussion and final commentsThe association of demyelinating polyneuropathy with a monoclonal peak in the electrophoresis results and findings of sclerotic bone lesions, the elevation of VEGF, lymph node organomegaly, and endocrinopathy, confirm the diagnosis of POEMS Syndrome.In this syndrome, neurological damage usually develops with a demyelinating pattern, greater axonal loss, and autonomic preservation. However, we report an atypical case, of neurological impairment with less axonal loss; and relevant dysautonomia.
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