Muscle cramping over the diagnosis

Abstract

A 44-year-old man with hypogonadism and adrenal insufficiency presented with transient blurred vision and halos around lights. Visual acuity was 20/20 in both eyes, and he had mild bilateral optic disk edema. Brain imaging was unremarkable, and lumbar puncture showed an opening pressure of 28.5 cm H2O with elevated protein. He also complained of muscle cramping, and magnetic resonance imaging of the spine demonstrated a heterogenous bone marrow signal. Bone survey showed a mixed lytic and sclerotic lesion within the left femur that proved to be a plasmacytoma. Serum protein electrophoresis had a small IgA spike, and plasma vascular endothelial growth factor (VEGF) was elevated. He was diagnosed with POEMS syndrome and underwent radiation to the plasmacytoma. Two years later he had a stable neuro-ophthalmologic exam with no signs of multiple myeloma. POEMS syndrome is a rare paraneoplastic syndrome from a plasma cell dyscrasia that may cause optic disk edema.

Keywords: POEMS syndrome; optic disk edema; papilledema; plasma cell dyscrasia; plasmacytoma; vascular endothelial growth factor.