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Disorders of the Mediastinum: Pleura and Chest Wall |

A Poems Syndrome Patient Associated With Positive TB-DNA Test of Bronchial Alveolus Lavage Fluid FREE TO VIEW

Chunhong Peng, PhD
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Guizhou Province People's Hospital, Guiyang, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A222. doi:10.1016/j.chest.2016.02.230
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SESSION TITLE: Pleura and Chest Wall

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: POEMS syndrome is a paraneoplastic disorder associated with an underlying plasma cell dyscrasia. The major clinical feature of the syndrome is a chronic progressive polyneuropathy with a predominant locomotor disability1.

CASE PRESENTATION: A man complaining of diarrhea, abdominal pain for 6 months was admitted to our hospital. There were bilateral axilla lymphadenectasis, unilateral hydrothorax and ascites. The TB-DNA test of bronchial alveolus lavage fluid and purified protein derivative of tuberculin (PPD) test were positive. A diagnosis of tuberculosis polyserositis was made and anti-TB therapy was administered. Diarrhea and abdominal pain were relieved to some extent, but two weeks was deteriorated. Drug-resistant tuberculosis was considered and second-line anti-TB drugs were prescribed, but ascitic and hydrothorax were not relieved. On endocrine testing, hypothyroidism was found. Serum protein electrophoresis showed an M-peak in the γ-fraction. A bone marrow study revealed that plasma cells accounted for 10-15%, and no atypical cells were seen. The lymphoglandula pathological biopsy demonstrated angiofollicular lymph node hyperplasia. The diagnosis of POEMS syndrome was established and chemotherapy was administered. After 3 months’ treatment, the ascites and hydrothorax were decreased.

DISCUSSION: POEMS syndrome is a paraneoplastic disorder associated with an underlying plasma cell dyscrasia. Edema and effusions occur frequently in POEMS syndrome2 and a current review of POEMS syndrome showed that neuropathy progression in POEMS syndrome is usually chronic and varies considerably among patients3. Effusion is the common clinical presentation in respiratory system and pleural tuberculosis should be considered in any adult or elderly patient with a unilateral pleural effusion. The average positive predictive value of TB-DNA test of bronchial specimens would be 96% according to meta-analysis. The disease could be neglected when unilateral effusion emerges without polyneuropathy symptoms. Therefore in refractory polyserositis resembling with tuberculous polyserositis, differential diagnosis including POEMS should be considered.

CONCLUSIONS: In conclusion, diagnosis in a short time from first symptoms is very important, to avoid the progression of typical of POEMS syndrome. From the case, we learned a lesson that in unusual refractory polyserositis resembling with tuberculous polyserositis, differential diagnosis including POEMS should be considered and AHSCT should be taken early once the diagnosis was established.

Reference #1: Dispenzieri A. POEMS syndrome. Blood Reviews 2007; 21:285-299

Reference #2: Nakanishi T, Sobue I, Toyokura Y, et al. The Crow-Fukase syndrome: a study of 102 cases in Japan. Neurology 1984; 34:712-720

Reference #3: Isose S, Misawa S, Kanai K, et al. POEMS syndrome with Guillan-Barre syndrome-like acute onset: a case report and review of neurological progression in 30 cases. J Neurol Neurosurg Psychiatry 2010

DISCLOSURE: The following authors have nothing to disclose: Chunhong Peng

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