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PAINFUL NEUROPATHY, MONOCLONAL GAMMOPATHY AND AMYLOID DEPOSITS: RESPONSE TO THERAPY IN 3 CASES
Publication year - 2002
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1046/j.1529-8027.2002.7011_15.x
Subject(s) - medicine , polyneuropathy , amyloidosis , prednisone , melphalan , monoclonal gammopathy of undetermined significance , biopsy , skin biopsy , gammopathy , serum protein electrophoresis , nerve biopsy , amyloid (mycology) , peripheral neuropathy , pathology , gastroenterology , multiple myeloma , monoclonal , diabetes mellitus , endocrinology , immunology , monoclonal antibody , antibody
Siciliano G. 1 , D'Avino C. 1 , Panichi V. 2 , Azzarà A. 3 , Del Corona A. 1 , Pollina L. 3 , Murri L. 11 Department of Neuroscience, 2 Department of Internal Medicine and 3 Department of Oncology—University of Pisa‐Italy Amyloidosis is a systemic disease with a wide organic involvement. Amyloidotic polyneuropathies may be genetic in their origin or present in association with a number of chronic inflammatory dysimmune disorders. We report on three patients affected by predominantly sensitive polyneuropathy, monoclonal gammopathy and amyloidosis. Patient 1. Woman, 72 years old, with a one year history of painful paraesthesias, ataxic gait and demyelinating predominantly sensitive polyneuropathy at 4 limbs also with involvement of sympathetic fibres. Blood protein electrophoresis showed a monoclonal gammopahty (IgG‐k) with normal bone marrow biopsy and positivity for amyloid at fat biopsy. The patient has been treated with melphalan 0.2 mg/Kg/day+prednisone 100 mg/day for 7 days each month for 6 months with good efficacy and only a transient reduction in platelet and white blood cells count. Patient 2. Man, 60 years old, new diagnosis of diabetes with a 9 month history of painful paraesthesias and hyposthenia, a demyelinating sensory‐motor polyneuropathy at 4 limbs. The patient presented an IgG‐λ monoclonal gammopathy with normal bone marrow biopsy, fat biopsy but not sural nerve biopsy positive for amyloid. The patient underwent melphalan+prednisone therapy, with insulinic control of glycemia. He presented a clear‐cut improvement in sensitive‐motor symptomatology. Patient 3. Man, 72 years old, with a 15 year history of ulcerous rectocolites. Since 1998 started complaining of paraesthesias and disaesthesias at four limbs associated with gait disturbances. The patient presented an IgG‐λ monoclonal gammopathy with normal bone marrow aspiration and elevated serum Interleukin‐6 levels, fat biopsy positive for amyloid, and high anti‐MAG antibodies titer (1:1). Because of RCU, melphalan therapy was excluded and the patient is at the moment under fludarabine (25 mg/m 2 /day) ev for 5 days each 6 weeks for 6 bouts.