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POEMS syndrome with pulmonary nocardiosis: A unique presentation.

Barve K, Karkhanis V, Joshi J - Lung India (2015 Mar-Apr)

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Topiwala National Medical College, BYL Nair Hospital, Mumbai, Maharashtra, India E-mail: drketakibarve@gmail.com.

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Sir, We present a case of a 52-year-old man who presented with bilateral lung cavities, bone lesions and demyelinating polyneuropathy... Chest examination revealed bilateral crackles... Neurological examination showed reduced power (3/5) in lower limbs, impaired touch and pain sensation and decreased deep tendon reflexes... A CT-guided biopsy of the lung lesion showed no evidence of malignancy... He thus satisfied all criteria required for diagnosis of POEMS syndrome... Finger clubbing was an associated feature... OM is a plasma cell dyscrasia characterized by sclerotic bone lesions and demyelinating polyneuropathy... M protein is usually IgG or IgA with lambda light chains and a bone marrow biopsy shows less than 5% increase in plasma cells or may be normal... Radiologically OM is always associated with sclerotic lesions though lytic lesions may be present... Our patient presented with the pulmonary manifestation of bilateral lung cavities, which were however due to Nocardia infection... This case is thus unique by its rare pulmonary manifestation and close resemblance to malignancy... It serves to remind the clinician to consider this syndrome whenever confronted with such a case presenting with multisystem involvement... Early diagnosis and therapy are crucial.

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Histopathology of a chest lesion with special stains demonstrating Nocardia
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Figure 4: Histopathology of a chest lesion with special stains demonstrating Nocardia

Mentions: Pulmonary manifestations of POEMS syndrome are common and include pulmonary hypertension, restrictive lung disease, respiratory muscle weakness, pleural effusions and diaphragmatic elevation as shown in a retrospective review conducted over 137 patients by Allam et al.[4] Our patient presented with the pulmonary manifestation of bilateral lung cavities, which were however due to Nocardia infection. Nocardiosis is an important opportunistic disease that can manifest as localized or disseminated infection. It tends to affect patients with underlying immunosuppression.[5] Patients with hematological disorders are a high-risk category for nocardiosis because of intrinsic immunodeficiency.[5] In our patient POEMS syndrome produced a disturbance in the immune system, hence pulmonary nocardiosis seems secondary to this. Pulmonary system is the most commonly involved organ system, infection being acquired by inhalation of airborne spores. It usually presents as nodular or escavated lesions.[5] Our patient also presented with multiple lung abscesses. Diagnosis is by demonstration of organism in smear and isolation by culture with modified Kinyon staining [Figure 4]. Sulphonamide group of antibiotics with or without trimethoprim have been regarded as the drug of choice. Prognosis in a patient with POEMS syndrome depends on the underlying plasma cell disorder. Prognosis is poor if effusions, ascites, edema or multiple lytic lesions are present. Cardio respiratory failure, renal failure, and infection are the common cause of death.[6] Our patient had developed a complication in form of pulmonary infection with nocardia manifesting as lung abscesses thereby accounting for his poor prognosis and mortality.


POEMS syndrome with pulmonary nocardiosis: A unique presentation.

Barve K, Karkhanis V, Joshi J - Lung India (2015 Mar-Apr)

Histopathology of a chest lesion with special stains demonstrating Nocardia
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372885&req=5

Figure 4: Histopathology of a chest lesion with special stains demonstrating Nocardia
Mentions: Pulmonary manifestations of POEMS syndrome are common and include pulmonary hypertension, restrictive lung disease, respiratory muscle weakness, pleural effusions and diaphragmatic elevation as shown in a retrospective review conducted over 137 patients by Allam et al.[4] Our patient presented with the pulmonary manifestation of bilateral lung cavities, which were however due to Nocardia infection. Nocardiosis is an important opportunistic disease that can manifest as localized or disseminated infection. It tends to affect patients with underlying immunosuppression.[5] Patients with hematological disorders are a high-risk category for nocardiosis because of intrinsic immunodeficiency.[5] In our patient POEMS syndrome produced a disturbance in the immune system, hence pulmonary nocardiosis seems secondary to this. Pulmonary system is the most commonly involved organ system, infection being acquired by inhalation of airborne spores. It usually presents as nodular or escavated lesions.[5] Our patient also presented with multiple lung abscesses. Diagnosis is by demonstration of organism in smear and isolation by culture with modified Kinyon staining [Figure 4]. Sulphonamide group of antibiotics with or without trimethoprim have been regarded as the drug of choice. Prognosis in a patient with POEMS syndrome depends on the underlying plasma cell disorder. Prognosis is poor if effusions, ascites, edema or multiple lytic lesions are present. Cardio respiratory failure, renal failure, and infection are the common cause of death.[6] Our patient had developed a complication in form of pulmonary infection with nocardia manifesting as lung abscesses thereby accounting for his poor prognosis and mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Topiwala National Medical College, BYL Nair Hospital, Mumbai, Maharashtra, India E-mail: drketakibarve@gmail.com.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, We present a case of a 52-year-old man who presented with bilateral lung cavities, bone lesions and demyelinating polyneuropathy... Chest examination revealed bilateral crackles... Neurological examination showed reduced power (3/5) in lower limbs, impaired touch and pain sensation and decreased deep tendon reflexes... A CT-guided biopsy of the lung lesion showed no evidence of malignancy... He thus satisfied all criteria required for diagnosis of POEMS syndrome... Finger clubbing was an associated feature... OM is a plasma cell dyscrasia characterized by sclerotic bone lesions and demyelinating polyneuropathy... M protein is usually IgG or IgA with lambda light chains and a bone marrow biopsy shows less than 5% increase in plasma cells or may be normal... Radiologically OM is always associated with sclerotic lesions though lytic lesions may be present... Our patient presented with the pulmonary manifestation of bilateral lung cavities, which were however due to Nocardia infection... This case is thus unique by its rare pulmonary manifestation and close resemblance to malignancy... It serves to remind the clinician to consider this syndrome whenever confronted with such a case presenting with multisystem involvement... Early diagnosis and therapy are crucial.

No MeSH data available.