Department of Nephrology, The Second Affiliated Hospital of Guizhou University of TCM, Guiyang, China.
Department of Nephrology, Chongqing Hechuan District Hospital of Traditional Chinese Medicine, Chongqing, China.
Medicine (Baltimore). 2024 Mar 1;103(9):e37200. doi: 10.1097/MD.0000000000037200.
This article presents the case of a patient with recurrent chronic diarrhea and cachexia who was misdiagnosed, followed by a literature review to summarize the reasons for misdiagnosis of POEMS syndrome and the treatment strategies.
The diagnosis and treatment of this patient suggest that with the improvement of M-protein detection levels, the diagnosis of patients with low M-protein levels, such as those with POEMS syndrome, has been greatly aided.
POEMS syndrome requires polyneuropathy and monoclonal plasma cell proliferation as mandatory diagnostic criteria. Therefore, patients presenting with polyneuropathy should routinely undergo M-protein testing and consider the possibility of POEMS syndrome.
The patient, in this case, was treated primarily with relatively conservative immunomodulatory agents.
During follow-up after treatment, the patient's diarrhea and malnutrition showed significant improvement.
POEMS syndrome has low clinical specificity and a high rate of misdiagnosis. However, once a definitive diagnosis is made, the treatment outcome is favorable.
本文介绍了一例反复出现慢性腹泻和恶病质的患者,该患者被误诊,随后进行文献复习,总结 POEMS 综合征误诊的原因和治疗策略。
该患者的诊断和治疗提示,随着 M 蛋白检测水平的提高,对 M 蛋白水平较低的患者(如 POEMS 综合征患者)的诊断有了很大帮助。
POEMS 综合征需要多发性神经病和单克隆浆细胞增殖作为强制性诊断标准。因此,出现多发性神经病的患者应常规进行 M 蛋白检测,并考虑 POEMS 综合征的可能性。
本例患者主要采用相对保守的免疫调节药物进行治疗。
治疗后随访时,患者的腹泻和营养不良情况明显改善。
POEMS 综合征的临床特异性较低,误诊率较高。然而,一旦明确诊断,治疗效果良好。