246-248
Clinicalrheurnatology, 1990, 9, N ~ 2
Case Report
Peripheral neuropathy, polymyalgia and arthralgia: a paraneoplastic syndrome associated with myeloma A.
SAMANTA,
D.
HILTON*,
S.
ROY**
G e n e r a l M e d i c i n e a n d ** R h e u m a t o l o g y , * P a t h o l o g y , L e i c e s t e r R o y a l Infirmary, L e i c e s t e r L E 1 5 W W , U.K. SUMMARY We describe a patient with peripheral neuropathy, polymyalgia, arthralgia and cervical vertebral osteosclerosis who was subsequently diagnosed to have fatal multiple myeloma with IgG gammopathy and lambda urinary chains. The initial presentation and clinical features are discussed. Keywords : Pheripheral Neuropathy, Polymyalgia, Arthralgia, Myeloma INTRODUCTION Peripheral neuropathy, in the elderly may be associated with a malignancy. We report a patient with IgG-lambda gammopathy who presented with peripheral neuropathic symptoms, and who had several unusual features of myeloma, with a progressive, fatal clinical course.
CASE H I S T O R Y A 72-year-old man was referred to the rheumatology service because of aching and dysesthesia in both feet, suspected to be "arthritis", for about 8 months. There was no significant past history, and on direct questioning admitted to intermittent pain affecting the upper arms, thighs, both wrists and shoulders, over the last six months. He had lost approximately half a stone in weight. On physical examination he was an elderly gentleman with a normal pulse and blood pres-
Received: 5 September 1989 Revision-accepted: 30 January 1990 Correspondence to: Dr. A. SAMANTA, Leicester Royal Infirmary, Leicester. LE1 5WW, UK.
sure. He had a patchy loss to all sensory modalities over both feet, roughly up to the midcalves. Both plantars were flexor, and sphincteric function was normal. There was some tenderness in the proximal muscles of all four limbs. H e had some swelling and pain in both wrists. Other joints were clinically normal. There was no splenomegaly or lymphadenopathy. Investigations showed a normal haemoglobin, white cell and platelet count, with normal red celt parameters. Plasma viscosity was 1.97 CP (1.5-1.72). CRP 3.8 mg% (
Clinicalrheurnatology, 1990, 9, N ~ 2
Case Report
Peripheral neuropathy, polymyalgia and arthralgia: a paraneoplastic syndrome associated with myeloma A.
SAMANTA,
D.
HILTON*,
S.
ROY**
G e n e r a l M e d i c i n e a n d ** R h e u m a t o l o g y , * P a t h o l o g y , L e i c e s t e r R o y a l Infirmary, L e i c e s t e r L E 1 5 W W , U.K. SUMMARY We describe a patient with peripheral neuropathy, polymyalgia, arthralgia and cervical vertebral osteosclerosis who was subsequently diagnosed to have fatal multiple myeloma with IgG gammopathy and lambda urinary chains. The initial presentation and clinical features are discussed. Keywords : Pheripheral Neuropathy, Polymyalgia, Arthralgia, Myeloma INTRODUCTION Peripheral neuropathy, in the elderly may be associated with a malignancy. We report a patient with IgG-lambda gammopathy who presented with peripheral neuropathic symptoms, and who had several unusual features of myeloma, with a progressive, fatal clinical course.
CASE H I S T O R Y A 72-year-old man was referred to the rheumatology service because of aching and dysesthesia in both feet, suspected to be "arthritis", for about 8 months. There was no significant past history, and on direct questioning admitted to intermittent pain affecting the upper arms, thighs, both wrists and shoulders, over the last six months. He had lost approximately half a stone in weight. On physical examination he was an elderly gentleman with a normal pulse and blood pres-
Received: 5 September 1989 Revision-accepted: 30 January 1990 Correspondence to: Dr. A. SAMANTA, Leicester Royal Infirmary, Leicester. LE1 5WW, UK.
sure. He had a patchy loss to all sensory modalities over both feet, roughly up to the midcalves. Both plantars were flexor, and sphincteric function was normal. There was some tenderness in the proximal muscles of all four limbs. H e had some swelling and pain in both wrists. Other joints were clinically normal. There was no splenomegaly or lymphadenopathy. Investigations showed a normal haemoglobin, white cell and platelet count, with normal red celt parameters. Plasma viscosity was 1.97 CP (1.5-1.72). CRP 3.8 mg% (
