Heavy metals intoxication in a patient with POEMS-like symptoms: a case report

Abstract

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) is a kind of plasma cell disease with complex clinical manifestations involving multiple systems. Metal poisonings through a mucocutaneous are rare in clinic and reported less in the literature. People may exposure to toxic metals through air, food, water, or inappropriate use of drugs. Acute or chronic poisonings can lead to various toxic effects on body tissues and organs. Both POEMS syndrome and heavy metal intoxication are uncommon with multifarious and nonspecific clinical manifestations. Here we describe a case of a 54-year-old man with polyarticular pain and IgA lambda type monoclonal protein in his serum. The diagnosis was confirmed by heavy metals testing in his urine and the herbal mixtures he took. This is the first available report of arsenic and mercury intoxication mimicking POEMS syndrome.

Keywords: POEMS syndrome; arsenic poisoning; heavy metals poisoning; mercury poisoning.

Figure 1

Serum with immune fixation electrophoresis and bone marrow biopsy. (A) There was IgA lambda type monoclonal immunoglobulin in serum of the patient on admission. (B) After 3 courses of DMPS treatment, there was still IgA Lamda type monoclonal immunoglobulin in serum of the patient (ELP: electrophoresis, G: IgG, A: IgA, M: IgM, K: kappa light chain, L: Lamda light chain, DMPS: sodium dimercaptosulphonate). (C, D) The bone marrow histologic examination (original magnification ×100 in C and ×400 in D).

Figure 2

PET-CT images of this patient. (A) The patient had no hepatosplenomegaly in PET-CT. (B) No enlarged lymph nodes were seen in this patient. (C) The patient had no osteosclerotic lesions as well.

Figure 3

The treatment process and heavy metals content of the patient. (A) The whole treatment process of the patient. Treatment of DMPS was performed on day 12, day 18 and day 25 of the patient’s hospitalization. (B) Heavy metals content in blood and (or) urine samples on day 6, day 12, and day 31 of the patient’s hospitalization. The herbal mixtures were grounded and diluted with NS into solid-liquid mixtures for testing. NS: normal saline.