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Reminder of important clinical lesson
CASE REPORT
POEMS syndrome in a patient with rheumatoid arthritis
  1. Takahiko Akagi,
  2. Tomoyuki Mukai,
  3. Shoko Kodama,
  4. Yoshitaka Morita
  1. Department of Rheumatology, Kawasaki Medical School, Kurashiki, Japan
  1. Correspondence to Dr Yoshitaka Morita, morita{at}med.kawasaki-m.ac.jp

Summary

Multiple myeloma has been reported to be associated with rheumatoid arthritis (RA). POEMS syndrome is a rare variant of multiple myeloma and is characterised by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes. We report the case of a 67-year-old patient with RA who developed numbness and tingling in both legs due to polyneuropathy. CT showed a massive right pleural effusion and a sclerotic lesion in the right ninth rib. Histopathological examination of the rib revealed IgA lambda-type plasmacytoma. Serum vascular endothelial growth factor was extremely high at 5530 pg/mL. We made a diagnosis of POEMS syndrome. A literature search of the PubMed database identified only two documented cases of POEMS syndrome in patients with RA. Neuropathies are reportedly more frequent in patients with RA than in the general population. Rheumatologists should consider POEMS syndrome in patients with RA and neurological symptoms.

  • rheumatoid arthritis
  • haematology (incl blood transfusion)
  • peripheral nerve disease

https://doi.org/10.1136/bcr-2017-220875

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    Footnotes

    • Contributors TA and YM involved in conception or design of the work. TA and SK are responsible for acquisition of data. TA, SK, TM and YM are responsible for analysis and interpretation of data. TA, TM and YM drafted the manuscript or revised.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.