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POEMS Syndrome: an Atypical Presentation with Chronic Diarrhoea and Asthenia
European Journal of Case Reports in Internal Medicine POEMS Syndrome: an Atypical Presentation with Chronic Diarrhoea and Asthenia Joana Alves Vaz1, Lilia Frada2, Maria Manuela Soares1, Alberto Mello e Silva1 1 Department of Internal Medicine, Egas Moniz Hospital, Lisbon, Portugal 2 Department of Gynecology and Obstetrics, Espirito Santo Hospital, Evora, Portugal Doi: 10.12890/2019_001241 - European Journal of Case Reports in Internal Medicine - © EFIM 2019 Received: 28/07/2019 Accepted: 13/11/2019 Published: 16/12/2019 How to cite this article: Alves Vaz J, Frada L, Soares MM, Mello e Silva A. POEMS syndrome: an atypical presentation with chronic diarrhoea and astenia. EJCRIM 2019;7: doi:10.12890/2019_001241. Conflicts of Interests: The Authors declare that there are no competing interest This article is licensed under a Commons Attribution Non-Commercial 4.0 License ABSTRACT POEMS syndrome is a rare paraneoplastic condition associated with polyneuropathy, organomegaly, monoclonal gammopathy, endocrine and skin changes. We report a case of a man with Castleman disease and monoclonal gammopathy, with a history of chronic diarrhoea and asthenia. Gastrointestinal involvement in POEMS syndrome is not frequently referred to in the literature and its physiopathology is not fully understood. Diagnostic criteria were met during hospitalization but considering the patient’s overall health condition, therapeutic options were limited. Current treatment for POEMS syndrome depends on the management of the underlying plasma cell disorder. This report outlines the importance of a thorough review of systems and a physical examination to allow an attempted diagnosis and appropriate treatment. LEARNING POINTS • POEMS syndrome should be suspected in the presence of peripheral polyneuropathy associated with monoclonal gammopathy; diagnostic workup is challenging and delay in treatment is very common. -
Blueprint Genetics Craniosynostosis Panel
Craniosynostosis Panel Test code: MA2901 Is a 38 gene panel that includes assessment of non-coding variants. Is ideal for patients with craniosynostosis. About Craniosynostosis Craniosynostosis is defined as the premature fusion of one or more cranial sutures leading to secondary distortion of skull shape. It may result from a primary defect of ossification (primary craniosynostosis) or, more commonly, from a failure of brain growth (secondary craniosynostosis). Premature closure of the sutures (fibrous joints) causes the pressure inside of the head to increase and the skull or facial bones to change from a normal, symmetrical appearance resulting in skull deformities with a variable presentation. Craniosynostosis may occur in an isolated setting or as part of a syndrome with a variety of inheritance patterns and reccurrence risks. Craniosynostosis occurs in 1/2,200 live births. Availability 4 weeks Gene Set Description Genes in the Craniosynostosis Panel and their clinical significance Gene Associated phenotypes Inheritance ClinVar HGMD ALPL Odontohypophosphatasia, Hypophosphatasia perinatal lethal, AD/AR 78 291 infantile, juvenile and adult forms ALX3 Frontonasal dysplasia type 1 AR 8 8 ALX4 Frontonasal dysplasia type 2, Parietal foramina AD/AR 15 24 BMP4 Microphthalmia, syndromic, Orofacial cleft AD 8 39 CDC45 Meier-Gorlin syndrome 7 AR 10 19 EDNRB Hirschsprung disease, ABCD syndrome, Waardenburg syndrome AD/AR 12 66 EFNB1 Craniofrontonasal dysplasia XL 28 116 ERF Craniosynostosis 4 AD 17 16 ESCO2 SC phocomelia syndrome, Roberts syndrome -
Orphanet Report Series Rare Diseases Collection
Marche des Maladies Rares – Alliance Maladies Rares Orphanet Report Series Rare Diseases collection DecemberOctober 2013 2009 List of rare diseases and synonyms Listed in alphabetical order www.orpha.net 20102206 Rare diseases listed in alphabetical order ORPHA ORPHA ORPHA Disease name Disease name Disease name Number Number Number 289157 1-alpha-hydroxylase deficiency 309127 3-hydroxyacyl-CoA dehydrogenase 228384 5q14.3 microdeletion syndrome deficiency 293948 1p21.3 microdeletion syndrome 314655 5q31.3 microdeletion syndrome 939 3-hydroxyisobutyric aciduria 1606 1p36 deletion syndrome 228415 5q35 microduplication syndrome 2616 3M syndrome 250989 1q21.1 microdeletion syndrome 96125 6p subtelomeric deletion syndrome 2616 3-M syndrome 250994 1q21.1 microduplication syndrome 251046 6p22 microdeletion syndrome 293843 3MC syndrome 250999 1q41q42 microdeletion syndrome 96125 6p25 microdeletion syndrome 6 3-methylcrotonylglycinuria 250999 1q41-q42 microdeletion syndrome 99135 6-phosphogluconate dehydrogenase 67046 3-methylglutaconic aciduria type 1 deficiency 238769 1q44 microdeletion syndrome 111 3-methylglutaconic aciduria type 2 13 6-pyruvoyl-tetrahydropterin synthase 976 2,8 dihydroxyadenine urolithiasis deficiency 67047 3-methylglutaconic aciduria type 3 869 2A syndrome 75857 6q terminal deletion 67048 3-methylglutaconic aciduria type 4 79154 2-aminoadipic 2-oxoadipic aciduria 171829 6q16 deletion syndrome 66634 3-methylglutaconic aciduria type 5 19 2-hydroxyglutaric acidemia 251056 6q25 microdeletion syndrome 352328 3-methylglutaconic -
Medical Genetics and Genomic Medicine in the United States of America
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by George Washington University: Health Sciences Research Commons (HSRC) Himmelfarb Health Sciences Library, The George Washington University Health Sciences Research Commons Pediatrics Faculty Publications Pediatrics 7-1-2017 Medical genetics and genomic medicine in the United States of America. Part 1: history, demographics, legislation, and burden of disease. Carlos R Ferreira George Washington University Debra S Regier George Washington University Donald W Hadley P Suzanne Hart Maximilian Muenke Follow this and additional works at: https://hsrc.himmelfarb.gwu.edu/smhs_peds_facpubs Part of the Genetics and Genomics Commons APA Citation Ferreira, C., Regier, D., Hadley, D., Hart, P., & Muenke, M. (2017). Medical genetics and genomic medicine in the United States of America. Part 1: history, demographics, legislation, and burden of disease.. Molecular Genetics and Genomic Medicine, 5 (4). http://dx.doi.org/10.1002/mgg3.318 This Journal Article is brought to you for free and open access by the Pediatrics at Health Sciences Research Commons. It has been accepted for inclusion in Pediatrics Faculty Publications by an authorized administrator of Health Sciences Research Commons. For more information, please contact [email protected]. GENETICS AND GENOMIC MEDICINE AROUND THE WORLD Medical genetics and genomic medicine in the United States of America. Part 1: history, demographics, legislation, and burden of disease Carlos R. Ferreira1,2 , Debra S. Regier2, Donald W. Hadley1, P. Suzanne Hart1 & Maximilian Muenke1 1National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 2Rare Disease Institute, Children’s National Health System, Washington, District of Columbia Correspondence Carlos R. -
Genetic Testing Guidelines
GUIDELINE Genetic Testing Guidelines Categories This Guideline Applies To: Clinical Care Management CM, TCHP Texas Children's Health Plan Guidelines, Utilization Management UM Guideline # 6181 Document Owner Bhavana Babber GUIDELINE STATEMENT: Texas Children's Health Plan (TCHP) performs authorization of genetic testing requests. PRIOR AUTHORIZATION GUIDELINES 1. Genetic testing conducted by out-of-network providers will be treated as out-of-network requests and will comply with the out-of-network authorization Guidelines. 2. Requests for Noninvasive Prenatal Testing will comply with TCHP Noninvasive Prenatal Testing Guidelines. 3. All requests for prior authorization for genetic testing are received via fax, phone or mail by the Utilization Management Department and processed during normal business hours. 4. The Utilization Management professional receiving the request evaluates the submitted information to determine if the documentation supports the genetic testing as an eligible service. 5. To request prior authorization for genetic testing, documentation supporting the medical necessity of the test requested must be provided. 6. TCHP will apply clinical criteria in the current Texas Medicaid Provider Manual (TMPPM) at the time of the request when applicable for the following: 6.1.BRCA gene mutation analysis 6.2.Genetic Testing for colorectal cancer 6.3.Cytogenetic testing 6.4.Pharmacogenetic Testing Version #: 5 Genetic Testing Guidelines Page 1 of 10 Printed copies are for reference only. Please refer to the electronic copy for the latest version. GUIDELINE 6.5. A request for retroactive authorization must be submitted no later than seven calendar days beginning the day after the lab draw is performed per TMPPM 7. Whole genome sequencing (code 81415) requires preauthorization on a case-by-case basis. -
Orphanet Report Series Rare Diseases Collection
Orphanet Report Series Rare Diseases collection January 2013 Disease Registries in Europe www.orpha.net 20102206 Table of contents Methodology 3 List of rare diseases that are covered by the listed registries 4 Summary 13 1- Distribution of registries by country 13 2- Distribution of registries by coverage 14 3- Distribution of registries by affiliation 14 Distribution of registries by country 15 European registries 38 International registries 41 Orphanet Report Series - Disease Registries in Europe - January 2013 2 http://www.orpha.net/orphacom/cahiers/docs/GB/Registries.pdf Methodology Patient registries and databases constitute key instruments to develop clinical research in the field of rare diseases (RD), to improve patient care and healthcare planning. They are the only way to pool data in order to achieve a sufficient sample size for epidemiological and/or clinical research. They are vital to assess the feasibility of clinical trials, to facilitate the planning of appropriate clinical trials and to support the enrolment of patients. Registries of patients treated with orphan drugs are particularly relevant as they allow the gathering of evidence on the effectiveness of the treatment and on its possible side effects, keeping in mind that marketing authorisation is usually granted at a time when evidence is still limited although already somewhat convincing. This report gather the information collected by Orphanet so far, regarding systematic collections of data for a specific disease or a group of diseases. Cancer registries are listed only if they belong to the network RARECARE or focus on a rare form of cancer. The report includes data about EU countries and surrounding countries participating to the Orphanet consortium. -
2016 Essentials of Dermatopathology Slide Library Handout Book
2016 Essentials of Dermatopathology Slide Library Handout Book April 8-10, 2016 JW Marriott Houston Downtown Houston, TX USA CASE #01 -- SLIDE #01 Diagnosis: Nodular fasciitis Case Summary: 12 year old male with a rapidly growing temple mass. Present for 4 weeks. Nodular fasciitis is a self-limited pseudosarcomatous proliferation that may cause clinical alarm due to its rapid growth. It is most common in young adults but occurs across a wide age range. This lesion is typically 3-5 cm and composed of bland fibroblasts and myofibroblasts without significant cytologic atypia arranged in a loose storiform pattern with areas of extravasated red blood cells. Mitoses may be numerous, but atypical mitotic figures are absent. Nodular fasciitis is a benign process, and recurrence is very rare (1%). Recent work has shown that the MYH9-USP6 gene fusion is present in approximately 90% of cases, and molecular techniques to show USP6 gene rearrangement may be a helpful ancillary tool in difficult cases or on small biopsy samples. Weiss SW, Goldblum JR. Enzinger and Weiss’s Soft Tissue Tumors, 5th edition. Mosby Elsevier. 2008. Erickson-Johnson MR, Chou MM, Evers BR, Roth CW, Seys AR, Jin L, Ye Y, Lau AW, Wang X, Oliveira AM. Nodular fasciitis: a novel model of transient neoplasia induced by MYH9-USP6 gene fusion. Lab Invest. 2011 Oct;91(10):1427-33. Amary MF, Ye H, Berisha F, Tirabosco R, Presneau N, Flanagan AM. Detection of USP6 gene rearrangement in nodular fasciitis: an important diagnostic tool. Virchows Arch. 2013 Jul;463(1):97-8. CONTRIBUTED BY KAREN FRITCHIE, MD 1 CASE #02 -- SLIDE #02 Diagnosis: Cellular fibrous histiocytoma Case Summary: 12 year old female with wrist mass. -
Wednesday Slide Conference 2008-2009
PROCEEDINGS DEPARTMENT OF VETERINARY PATHOLOGY WEDNESDAY SLIDE CONFERENCE 2008-2009 ARMED FORCES INSTITUTE OF PATHOLOGY WASHINGTON, D.C. 20306-6000 2009 ML2009 Armed Forces Institute of Pathology Department of Veterinary Pathology WEDNESDAY SLIDE CONFERENCE 2008-2009 100 Cases 100 Histopathology Slides 249 Images PROCEEDINGS PREPARED BY: Todd Bell, DVM Chief Editor: Todd O. Johnson, DVM, Diplomate ACVP Copy Editor: Sean Hahn Layout and Copy Editor: Fran Card WSC Online Management and Design Scott Shaffer ARMED FORCES INSTITUTE OF PATHOLOGY Washington, D.C. 20306-6000 2009 ML2009 i PREFACE The Armed Forces Institute of Pathology, Department of Veterinary Pathology has conducted a weekly slide conference during the resident training year since 12 November 1953. This ever- changing educational endeavor has evolved into the annual Wednesday Slide Conference program in which cases are presented on 25 Wednesdays throughout the academic year and distributed to 135 contributing military and civilian institutions from around the world. Many of these institutions provide structured veterinary pathology resident training programs. During the course of the training year, histopathology slides, digital images, and histories from selected cases are distributed to the participating institutions and to the Department of Veterinary Pathology at the AFIP. Following the conferences, the case diagnoses, comments, and reference listings are posted online to all participants. This study set has been assembled in an effort to make Wednesday Slide Conference materials available to a wider circle of interested pathologists and scientists, and to further the education of veterinary pathologists and residents-in-training. The number of histopathology slides that can be reproduced from smaller lesions requires us to limit the number of participating institutions. -
Statistical Analysis Plan
Cover Page for Statistical Analysis Plan Sponsor name: Novo Nordisk A/S NCT number NCT03061214 Sponsor trial ID: NN9535-4114 Official title of study: SUSTAINTM CHINA - Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Document date: 22 August 2019 Semaglutide s.c (Ozempic®) Date: 22 August 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL Clinical Trial Report Status: Final Appendix 16.1.9 16.1.9 Documentation of statistical methods List of contents Statistical analysis plan...................................................................................................................... /LQN Statistical documentation................................................................................................................... /LQN Redacted VWDWLVWLFDODQDO\VLVSODQ Includes redaction of personal identifiable information only. Statistical Analysis Plan Date: 28 May 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL UTN:U1111-1149-0432 Status: Final EudraCT No.:NA Page: 1 of 30 Statistical Analysis Plan Trial ID: NN9535-4114 Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Author Biostatistics Semaglutide s.c. This confidential document is the property of Novo Nordisk. No unpublished information contained herein may be disclosed without prior written approval from Novo Nordisk. Access to this document must be restricted to relevant parties.This -
POEMS Syndrome Is Notknown
UAMS Information on POEMS SYNDROME What is POEMS Syndrome? POEMS syndrome have an increased number of POEMS syndrome is a rare, multi-system blood plasma cells. disorder. Symptoms The acronym “POEMS” stands for: olyneuropathy is characterized by chronic, Pprogressive disease affecting the peripheral P – Polyneuropathy nervous system. The peripheral nervous system O – Organomegaly consists of the motor and sensory nerves that connect E – Endocrinopathy the brain and spinal cord (central nervous system) M – Monoclonal protein to the rest of the body. Individuals with POEMS S – Skin changes syndrome experience numbness, tingling, feelings of coldness, and weakness, starting in the toes and feet and progressively working its way upwards. Over A diagnosis of POEMS is determined by the time, the hands can be affected. presence of a monoclonal plasma cell disorder, peripheral neuropathy, and one or more of the following: osteosclerotic bone lesions, organomegaly, rganomegaly refers to abnormal enlargement endocrinopathy, skin changes, increased levels of Oof the spleen, liver and lymph nodes. Swelling, vascular endothelial growth factor, and swelling. especially of the lymph nodes, may be present. Biopsy of enlarged lymph nodes may reveal Castleman Disease (a rare disease of lymph nodes and related Key Statistics tissues that results from the overgrowth of the cells in the body’s lymphatic system). POEMS syndrome is extremely rare. It affects more men than women, and typically occurs in one’s 50’s. The exact incidence is unknown. ndocrinopathy refers to abnormalities in Ethe endocrine system (the network of glands Causes that secrete hormones into the circulatory system). Abnormal hormone levels can lead to hypothyroidism The cause of POEMS syndrome is not known. -
POEMS Syndrome: Failure of Newly Suggested Diagnostic Criteria to Anticipate the Development of the Syndrome
American Journal of Hematology 79:316–318 (2005) POEMS Syndrome: Failure of Newly Suggested Diagnostic Criteria to Anticipate the Development of the Syndrome Ofran Yishay* and Elinav Eran Department of Medicine, Hadassah Hebrew University Medical Center, Mount Scopus Campus, Jerusalem, Israel POEMS syndrome is a unique clinical entity. Although it’s a diagnosis of exclusion, it was previously described by the presence of several typical characteristics as parapro- teinemia, polyneuropathy, organomegaly, endocrinopathy, and skin changes. Recently, new criteria were proposed, and the presence of two major and one minor criterion was claimed to suffice for a diagnosis. Both methods considered other important character- istics germane to the syndrome unessential for diagnosis. Retrospective evaluation of patients with lymphoproliferative disease was carried out to reveal the presence of the syndrome according to these different methods. Patients’ clinical progression during follow-up will be used to validate the criteria’s sensitivity and specificity. Six hundred twenty-nine consecutive files of patients with paraproteinemia who were followed-up at a tertiary medical center were reviewed. Of 12 patients who fulfilled the new criteria for diagnosis of POEMS, 3 remain stable during long-term follow-up and only 5 finally devel- oped the full-blown syndrome. Four patients developed other diseases that accounted for their clinical findings. Patients presenting with neuronal vasculitic changes on biopsy, k light-chain monoclonal gammopathy, and cryoglobulinemia were unlikely to develop POEMS syndrome, even though they fulfilled the newly suggested criteria. Although they are not in the criteria, sclerotic bone lesions were found only in patients who eventually developed the full syndrome. -
General Disease Finder
General Disease Finder This overview will help to fi nd neuromuscular disease patterns in the different sections Cushing’s disease, steroid myopathy; Addison’s disease, general muscle weakness Adrenal dysfunction Periodic paralysis Aldosteronism Tetanic muscles CN: VII AIDS Polyneuropathies: infl ammatory, immune mediated, treatment related Myopathies: infl ammatory, treatment related Neoplastic: lymphoma (direct invasion) Opportunistic infections: CMV, toxoplasmosis, Cryptococcus , HSV Candida, Varicella, Histoplasma, TBC, Aspergillus CMV polyradiculomyelopathy Herpes zoster radiculitis Syphilitic radiculopathy Treatment related: polyneuropathy/myopathy Ddl, ddC, foscarnet, isoniazid Zidovudine Polyneuropathy (distal, rarely proximal) Alcohol Mononeuropathy – radial nerve (compression) Myopathy Acute necrotizing myopathy and myoglobinuria Chronic proximal weakness Hypokalemic paralysis Myoglobinuria Compartment syndromes (prolonged compression) Familial amyloid polyneuropathies Amyloid Transthyretin Neuropathy Sensorimotor neuropathy Autonomic (continued) E.L. Feldman et al., Atlas of Neuromuscular Diseases, 299 DOI 10.1007/978-3-7091-1605-0, © Springer-Verlag Wien 2014 300 General Disease Finder Autonomic involvement Primary/secondary Apolipoprotein A-1 Polyneuropathy, painful, hearing loss Gelsolin type V, VII, and other CN Mild polyneuropathy Primary amyloidosis (AL) Deposition of immunoglobulin light chains in tissue Adrenal dysfunction Aldosteronism AIDS Alcoholism Amyloid Painful neuropathy Autonomic involvement Carpal tunnel syndrome