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      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Local Treatment with Triamcinolone Acetonide and Bevacizumab for Ocular Symptoms in a Patient with POEMS Syndrome

      case-report

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          Abstract

          Purpose

          To report our experience in managing a case of bilateral optic disc oedema and unilateral cystoid macular oedema with a posterior subtenon (PST) injection of triamcinolone acetonide and intravitreal bevacizumab (IVB) in a patient with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome.

          Case Report

          A 50-year-old healthy woman complaining of bilateral blurred vision for several days was referred to the ophthalmologist. An eye examination showed a bilateral optic disc swelling and small preretinal haemorrhages. In addition, a peripheral neuropathy was found. Laboratory tests showed elevated levels of M-protein type IgA of 1.4 g/l and a vascular endothelial growth factor (VEGF) concentration of 6.1 ng/ml. The cerebrospinal fluid protein content was 131 mg/dl. An abdominal CT scan revealed hepatosplenomegaly. The diagnosis of POEMS syndrome was made based on the polyneuropathy, hepatosplenomegaly, IgA lambda monoclonal proteinemia, and optic disc swelling. As vision declined, 40 mg PST injection of triamcinolone was given bilaterally. Ten weeks thereafter, 2 IVB injections of 2.5 mg were administered to the left eye, with a 4-week interval. Because of an incomplete recovery of her visual functions, diarrhoea and general malaise, melphalan, followed by autologous peripheral blood stem cell transplantation, was initiated. After systemic treatment, she had no visual complaints anymore, the optic disc oedema had resolved, and the VEGF serum concentration had normalized.

          Discussion

          Local treatment with IVB and PST injection of triamcinolone can be an option for ocular symptoms in POEMS syndrome. However, given the incomplete recovery of the ocular abnormalities and the other symptoms, systemic treatment remains standard.

          Related collections

          Most cited references13

          • Record: found
          • Abstract: found
          • Article: not found

          The Crow-Fukase syndrome: a study of 102 cases in Japan.

          Clinical manifestations of 102 cases with the Crow- Fukase syndrome (the syndrome of polyneuropathy, anasarca, skin changes, endocrinopathy, dysglobulinemia, and organomegaly), with or without myeloma, were reviewed. Fifty-six cases with myeloma consisted of 31 with osteosclerotic, 17 with mixed osteosclerotic and osteolytic, and 8 with osteolytic. Forty-six cases without myeloma consisted of 2 with extramedullary plasmacytoma, 33 with M protein alone, and 11 with polyclonal protein alone. There was no significant difference in incidence of the major clinical manifestations between the two groups with and without myeloma. They had a common characteristic histologic finding of the lymph node resembling that of Castleman's disease.
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            • Record: found
            • Abstract: not found
            • Article: not found

            Greatly raised vascular endothelial growth factor (VEGF) in POEMS syndrome.

              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Bevacizumab therapy for POEMS syndrome.

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                Author and article information

                Journal
                Case Rep Ophthalmol
                Case Rep Ophthalmol
                COP
                Case Reports in Ophthalmology
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch )
                1663-2699
                Sep-Dec 2014
                3 December 2014
                3 December 2014
                : 5
                : 3
                : 416-422
                Affiliations
                [1] aDepartment of Ophthalmology, Reinier de Graaf Group, Delft, The Netherlands
                [2] bDepartment of Neurology, Reinier de Graaf Group, Delft, The Netherlands
                [3] cDepartment of Haematology and Oncology, Reinier de Graaf Group, Delft, The Netherlands
                [4] dDepartment of Rehabilitation and Physiotherapy, Medical University of Lublin, Lublin, Poland
                Author notes
                *Marcin G. Prost, MD, Department of Ophthalmology, Reinier de Graaf Group, Reinier de Graafweg 3-11, NL-2625 AD Delft (The Netherlands), E-Mail m.prost@ 123456rdgg.nl
                Article
                cop-0005-0416
                10.1159/000369856
                4280463
                d7e717b0-7b41-415b-a936-5879e22d3b2a
                Copyright © 2014 by S. Karger AG, Basel

                This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on http://www.karger.com and the terms of this license are included in any shared versions.

                History
                Page count
                Figures: 3, Tables: 1, References: 11, Pages: 7
                Categories
                Published online: December, 2014

                poems syndrome,optic disc oedema,macular oedema,bevacizumab,triamcinolone

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