ABSTRACT
POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) is a rare multisystemic disease of unknown pathogenesis. Proinflammatory and proangiogenic cytokines play important roles in its pathogenesis. POEMS syndrome is a rare cause of ascites. Until now, the coexistence of POEMS syndrome and hepatitis B has not been reported. In this case report, we present a 48-year-old male patient who presented with malaise, fatigue, diarrhea, and abdominal swelling. Organomegaly, endocrinopathy, ascites, skin changes, and polyneuropathy were identified, and we arrived at a diagnosis of POEMS syndrome. The patient was administered methylprednisolone 64 mg/day, lamivudine 100 mg/day, calcium 1.5 g/day, and calcitriol 0.5 µg/day. The patient's clinical manifestations had moderately resolved at the follow-up visits. At the end of 6 months of follow-up, his ascites was minimally reduced, and his neurologic manifestations had not lessened. The present case shows that accurate diagnosis is required for the management of patients with coexisting POEMS syndrome and hepatitis B.
Subject(s)
Hepatitis B/complications , Hepatitis B/diagnosis , POEMS Syndrome/complications , POEMS Syndrome/diagnosis , Anti-HIV Agents/therapeutic use , Diagnosis, Differential , Hepatitis B/drug therapy , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , POEMS Syndrome/drug therapyABSTRACT
Hepatotoxicity may occasionally develop over the course of treatment with proton pump inhibitors (PPIs). Although skin reactions, interstitial nephritis, pancytopenia, anaphylaxis, and generalized edema have been reported to be associated with PPIs, hepatotoxicity associated with oral pantoprazole is very rare. In this report, we present a case of hepatotoxicity in a 35-year-old man who received pantoprazole (40 mg/day) for acute gastritis. One week after discontinuation of pantoprazole, his liver function began to improve, and the patient gradually fully recovered. Although this toxicity occurs only infrequently, pantoprazole should be considered as a rare hepatotoxic agent in the literature.
Subject(s)
2-Pyridinylmethylsulfinylbenzimidazoles/adverse effects , Abdominal Pain/chemically induced , Abdominal Pain/diagnosis , Chemical and Drug Induced Liver Injury/diagnosis , Chemical and Drug Induced Liver Injury/etiology , Abdominal Pain/prevention & control , Anti-Ulcer Agents/adverse effects , Chemical and Drug Induced Liver Injury/prevention & control , Diagnosis, Differential , Humans , Male , Pantoprazole , Proton Pump Inhibitors/adverse effects , Rare Diseases/chemically induced , Rare Diseases/diagnosis , Treatment OutcomeSubject(s)
Hashimoto Disease/complications , Hypertension, Portal/diagnosis , Hypertension, Portal/etiology , Liver Cirrhosis/diagnosis , Liver Cirrhosis/etiology , Pancytopenia/diagnosis , Pancytopenia/etiology , Splenomegaly/diagnosis , Splenomegaly/etiology , Adult , Female , Humans , Idiopathic Noncirrhotic Portal HypertensionABSTRACT
BACKGROUND: Restless legs syndrome (RLS) is a common neurological condition characterized by uncomfortable and unpleasant sensations in the legs that are relieved by movement. It is frequently idiopathic, sometimes associated with specific disorders such as malignancies. Because there is no study relevant to RLS in Multiple Myeloma (MM), we aimed to evaluate the frequency of RLS in MM patients during chemotherapy and examined the relationship between presence of RLS and depression and anxiety in these patients. METHODS: We enrolled a population of 62 adult MM patients for RLS features. RLS was ascertained in MM patients by both the presence of the four essential International RLS Study Group diagnostic criteria and neurological examination. The International RLS Study Group rating scale was used to measure RLS severity. Hospital Anxiety and Depression Scale (HADS) was used to evaluate the levels of depression and anxiety and Short Form-36 (SF-36) to evaluate health related quality of life (HRQOL). RESULTS: A total of 62 MM patients were evaluated. Among them 11 were identified by the screening questionnaire to meet the criteria for RLS (17.74%). MM patients with RLS had higher levels of depression (P < 0.01) and anxiety (P < 0.01) and poorer HRQOL compared with those without RLS. CONCLUSIONS: The frequency of RLS in MM patients is higher than that of expected in the general population. MM patients afflicted by RLS have significantly higher levels of depression, anxiety and poorer HRQOL. Recognition and treatment of RLS in MM patients may be an important target in clinical management and may improve overall health outcomes in these patients.
