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A Man with Paraneoplastic Retinopathy plus Small Fiber Polyneuropathy Associated with Waldenström Macroglobulinemia (Lymphoplasmacytic Lymphoma): Insights into Mechanisms.
[waldenström macroglobulinemia]
Abstract
Purpose
:
To
report
a
well-characterized
Waldenström
's
macroglobulinemia
(
WM
)
case
that
provides
insight
into
the
mechanisms
of
two
paraneoplastic
complications
-
-
cancer-associated
retinopathy
(
CAR
)
and
small
fiber
polyneuropathy
(
SFPN
)
.
Methods
:
Retrospective
medical
chart
review
.
Results
:
A
58
-
year
old
man
with
WM
developed
vision
loss
and
bilateral
lower
extremity
pain
.
CAR
was
diagnosed
by
history
,
a
depressed
electroretinogram
(
ERG
)
and
positive
anti-
retinal
antibodies
.
SFPN
diagnosis
was
based
on
abnormal
autonomic
nerve
function
testing
and
a
distal
-
leg
skin
biopsy
that
demonstrated
absent
epidermal
small
-fiber
innervation
,
IgM
and
complement
deposition
and
microvasculopathy
.
Plasma
exchange
(
PLEX
)
led
to
dramatic
pain
relief
and
subjective
improvement
in
eye
symptoms
along
with
improvement
of
some
ERG
parameters
.
Repeat
skin
biopsy
after
treatment
showed
less
microvascular
abnormalities
and
decreased
complement
deposition
.
Conclusions
:
The
concurrence
of
CAR
and
SFPN
in
this
patient
suggest
that
both
were
complications
of
WM
and
their
common
response
to
PLEX
suggests
co
-mediation
by
humoral
factors
that
accessed
target
antigens
through
IgM-triggered
,
complement-mediated
vascular
damage
.
Diseases
Validation
Diseases presenting
"pain"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
aniridia
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital diaphragmatic hernia
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dentin dysplasia
dracunculiasis
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial mediterranean fever
focal myositis
hirschsprung disease
hodgkin lymphoma, classical
holt-oram syndrome
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
malignant atrophic papulosis
neuralgic amyotrophy
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
scrub typhus
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
trochlear dysplasia
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
wolf-hirschhorn syndrome
This symptom has already been validated