POEMS syndrome differential diagnosis: Difference between revisions

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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''POEMS syndrome (Demyelinating)'''<ref name="pmid8608236">{{cite journal |vauthors=Gherardi RK, Bélec L, Soubrier M, Malapert D, Zuber M, Viard JP, Intrator L, Degos JD, Authier FJ |title=Overproduction of proinflammatory cytokines imbalanced by their antagonists in POEMS syndrome |journal=Blood |volume=87 |issue=4 |pages=1458–65 |date=February 1996 |pmid=8608236 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''POEMS syndrome (Demyelinating)'''<ref name="pmid8608236">{{cite journal |vauthors=Gherardi RK, Bélec L, Soubrier M, Malapert D, Zuber M, Viard JP, Intrator L, Degos JD, Authier FJ |title=Overproduction of proinflammatory cytokines imbalanced by their antagonists in POEMS syndrome |journal=Blood |volume=87 |issue=4 |pages=1458–65 |date=February 1996 |pmid=8608236 |doi= |url=}}</ref>
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* Monoclonal plasma cell proliferation  
* [[Monoclonal]] [[plasma cell]] proliferation  
* Cytokine storm (IL-1, IL-6, IL-12, TNF alpha, VEGF)
* Cytokine storm (IL-1, IL-6, IL-12, TNF alpha, VEGF)
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* Symmetrical, ascending chronic progressive [[polyneuropathy]] with both [[Sensory system|sensory]] (pin-prick and vibration) and motor disability (motor > sensory)
* Symmetrical, ascending chronic progressive [[polyneuropathy]] with both [[Sensory system|sensory]] (pin-prick and vibration) and [[Motor skill|motor]] disability ([[Motor skill|motor]] > [[sensory]])
* Generalized/extermity pain
* Generalized/extermity [[pain]]
* Areflexia
* [[Areflexia]]
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*Increased number of [[Platelet|thrombocytes]]<ref name="pmid28894560">{{cite journal |vauthors=Nozza A |title=POEMS SYNDROME: an Update |journal=Mediterr J Hematol Infect Dis |volume=9 |issue=1 |pages=e2017051 |date=2017 |pmid=28894560 |pmc=5584767 |doi=10.4084/MJHID.2017.051 |url=}}</ref><ref name="pmid6248720">{{cite journal |vauthors=Bardwick PA, Zvaifler NJ, Gill GN, Newman D, Greenway GD, Resnick DL |title=Plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes: the POEMS syndrome. Report on two cases and a review of the literature |journal=Medicine (Baltimore) |volume=59 |issue=4 |pages=311–22 |date=July 1980 |pmid=6248720 |doi= |url=}}</ref><ref name="pmid6315993">{{cite journal |vauthors=Takatsuki K, Sanada I |title=Plasma cell dyscrasia with polyneuropathy and endocrine disorder: clinical and laboratory features of 109 reported cases |journal=Jpn. J. Clin. Oncol. |volume=13 |issue=3 |pages=543–55 |date=September 1983 |pmid=6315993 |doi= |url=}}</ref>
*Increased number of [[Platelet|thrombocytes]]<ref name="pmid28894560">{{cite journal |vauthors=Nozza A |title=POEMS SYNDROME: an Update |journal=Mediterr J Hematol Infect Dis |volume=9 |issue=1 |pages=e2017051 |date=2017 |pmid=28894560 |pmc=5584767 |doi=10.4084/MJHID.2017.051 |url=}}</ref><ref name="pmid6248720">{{cite journal |vauthors=Bardwick PA, Zvaifler NJ, Gill GN, Newman D, Greenway GD, Resnick DL |title=Plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes: the POEMS syndrome. Report on two cases and a review of the literature |journal=Medicine (Baltimore) |volume=59 |issue=4 |pages=311–22 |date=July 1980 |pmid=6248720 |doi= |url=}}</ref><ref name="pmid6315993">{{cite journal |vauthors=Takatsuki K, Sanada I |title=Plasma cell dyscrasia with polyneuropathy and endocrine disorder: clinical and laboratory features of 109 reported cases |journal=Jpn. J. Clin. Oncol. |volume=13 |issue=3 |pages=543–55 |date=September 1983 |pmid=6315993 |doi= |url=}}</ref>
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*Elevated levels of antitiroglobulin [[antibody]] and antithyroid peroxydase [[antibody]]<ref name="pmid25888197">{{cite journal |vauthors=Güneş HN, Bilecenoğlu NT, Şener U, Yoldaş TK |title=POEMS syndrome with peripheral and central nervous system demyelination: case report |journal=Neurologist |volume=19 |issue=4 |pages=101–3 |date=April 2015 |pmid=25888197 |doi=10.1097/NRL.0000000000000017 |url=}}</ref>
*Elevated levels of antitiroglobulin [[antibody]] and antithyroid peroxydase [[antibody]]<ref name="pmid25888197">{{cite journal |vauthors=Güneş HN, Bilecenoğlu NT, Şener U, Yoldaş TK |title=POEMS syndrome with peripheral and central nervous system demyelination: case report |journal=Neurologist |volume=19 |issue=4 |pages=101–3 |date=April 2015 |pmid=25888197 |doi=10.1097/NRL.0000000000000017 |url=}}</ref>
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* International Myeloma Working Group (IMWG) clinical and laboratory diagnostic criteria<ref name="urlIMWG | International Myeloma Working Group (IMWG) Criteria for the Diagnosis of Multiple Myeloma">{{cite web |url=http://imwg.myeloma.org/international-myeloma-working-group-imwg-criteria-for-the-diagnosis-of-multiple-myeloma/ |title=IMWG &#124; International Myeloma Working Group (IMWG) Criteria for the Diagnosis of Multiple Myeloma |format= |work= |accessdate=}}</ref>  
* [[POEMS syndrome diagnostic criteria|International Myeloma Working Group (IMWG) clinical and laboratory diagnostic criteria]]<ref name="urlIMWG | International Myeloma Working Group (IMWG) Criteria for the Diagnosis of Multiple Myeloma">{{cite web |url=http://imwg.myeloma.org/international-myeloma-working-group-imwg-criteria-for-the-diagnosis-of-multiple-myeloma/ |title=IMWG &#124; International Myeloma Working Group (IMWG) Criteria for the Diagnosis of Multiple Myeloma |format= |work= |accessdate=}}</ref>  
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Metabolic Syndrome (Axonal pathology)'''<ref name="pmid25897354">{{cite journal |vauthors=Schreiber AK, Nones CF, Reis RC, Chichorro JG, Cunha JM |title=Diabetic neuropathic pain: Physiopathology and treatment |journal=World J Diabetes |volume=6 |issue=3 |pages=432–44 |date=April 2015 |pmid=25897354 |doi=10.4239/wjd.v6.i3.432 |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Metabolic syndrome|Metabolic Syndrome]] (Axonal pathology)'''<ref name="pmid25897354">{{cite journal |vauthors=Schreiber AK, Nones CF, Reis RC, Chichorro JG, Cunha JM |title=Diabetic neuropathic pain: Physiopathology and treatment |journal=World J Diabetes |volume=6 |issue=3 |pages=432–44 |date=April 2015 |pmid=25897354 |doi=10.4239/wjd.v6.i3.432 |url=}}</ref>
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* Diabetes mellitus
* [[Diabetes mellitus]]
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* Symmetric sensorimotor distal polyneuropathy
* Symmetric sensorimotor distal polyneuropathy
* Asymmetric proximal neuropathy
* Asymmetric proximal neuropathy
* 3rd nerve palsy
* [[Oculomotor nerve palsy|3rd nerve palsy]]
* Carpel tunnel syndrome
* [[Carpal tunnel syndrome|Carpel tunnel syndrome]]
* Autonomic neuropathy
* [[Autonomic neuropathy]]
* "Glove and stocking" type pain
* "Glove and stocking" type pain
* Muscle wasting
* [[Muscle wasting]]
* Hammer toes
* [[Hammer toe|Hammer toes]]
* Polyuria
* [[Polyuria]]
* Polydipsia
* [[Polydipsia]]
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* Uncontrolled hyperglycemia
* Uncontrolled [[hyperglycemia]]
* Slowed nerve conduction
* Slowed [[Nerve conduction study|nerve conduction]]
* Small fiber dysfunction
* [[Small fiber peripheral neuropathy|Small fiber dysfunction]]
* Monofilament testing
* [[Monofilament|Monofilament testing]]
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* Fasting blood sugar level greater than equal to 126 mg/dl on 2 separate ocassions<ref name="pmid20042775">{{cite journal |vauthors= |title=Diagnosis and classification of diabetes mellitus |journal=Diabetes Care |volume=33 Suppl 1 |issue= |pages=S62–9 |date=January 2010 |pmid=20042775 |doi=10.2337/dc10-S062 |url=}}</ref>
* [[Fasting blood sugar|Fasting blood sugar level]] greater than equal to 126 mg/dl on 2 separate occasions<ref name="pmid20042775">{{cite journal |vauthors= |title=Diagnosis and classification of diabetes mellitus |journal=Diabetes Care |volume=33 Suppl 1 |issue= |pages=S62–9 |date=January 2010 |pmid=20042775 |doi=10.2337/dc10-S062 |url=}}</ref>
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* Anti-diabetic therapy
* [[Diabetes mellitus medical therapy|Anti-diabetic therapy]]
* Gabapentin
* [[Gabapentin]]
* Carbamazepine
* [[Carbamazepine]]
* Foot care
* [[Foot care]]
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Vitamin Deficiencies (Axonal Pathology)'''<ref name="pmid28129784">{{cite journal |vauthors=Ekabe CJ, Kehbila J, Abanda MH, Kadia BM, Sama CB, Monekosso GL |title=Vitamin B12 deficiency neuropathy; a rare diagnosis in young adults: a case report |journal=BMC Res Notes |volume=10 |issue=1 |pages=72 |date=January 2017 |pmid=28129784 |doi=10.1186/s13104-017-2393-3 |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Vitamin deficiencies|Vitamin Deficiencies]] (Axonal Pathology)'''<ref name="pmid28129784">{{cite journal |vauthors=Ekabe CJ, Kehbila J, Abanda MH, Kadia BM, Sama CB, Monekosso GL |title=Vitamin B12 deficiency neuropathy; a rare diagnosis in young adults: a case report |journal=BMC Res Notes |volume=10 |issue=1 |pages=72 |date=January 2017 |pmid=28129784 |doi=10.1186/s13104-017-2393-3 |url=}}</ref>
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* Vitamin B12 deficiency (Decreased S-adenosyl methionine)<ref name="pmid2738712">{{cite journal |vauthors=Doi T, Kawata T, Tadano N, Iijima T, Maekawa A |title=Effect of vitamin B12 deficiency on S-adenosylmethionine metabolism in rats |journal=J. Nutr. Sci. Vitaminol. |volume=35 |issue=1 |pages=1–9 |date=February 1989 |pmid=2738712 |doi= |url=}}</ref>
* [[Vitamin B12 deficiency]] (Decreased [[S-Adenosyl methionine|S-adenosyl methionine]])<ref name="pmid2738712">{{cite journal |vauthors=Doi T, Kawata T, Tadano N, Iijima T, Maekawa A |title=Effect of vitamin B12 deficiency on S-adenosylmethionine metabolism in rats |journal=J. Nutr. Sci. Vitaminol. |volume=35 |issue=1 |pages=1–9 |date=February 1989 |pmid=2738712 |doi= |url=}}</ref>
* Vitamin B1 deficiency
* [[Thiamine deficiency|Vitamin B1 deficiency]]
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* Primarily sensory deficiets
* Primarily [[sensory]] deficits
* Vibration and proprioception affected
* Vibration and [[proprioception]] affected
* Gait abnormalities
* [[Gait abnormality|Gait abnormalities]]
* Cognitive impairment
* [[Cognitive impairment]]
* Irritability
* [[Irritability]]
* Glossitis
* [[Glossitis]]


*
*
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* Anemia (megalosblastic in case of B12 deficiency)<ref name="pmid23262189">{{cite journal |vauthors=Berg RL, Shaw GR |title=Laboratory evaluation for vitamin B12 deficiency: the case for cascade testing |journal=Clin Med Res |volume=11 |issue=1 |pages=7–15 |date=February 2013 |pmid=23262189 |doi=10.3121/cmr.2012.1112 |url=}}</ref>
* [[Anemia]] ([[Megaloblastic Anemias|megaloblastic]] in case of [[Vitamin B12 deficiency|B12 deficiency]])<ref name="pmid23262189">{{cite journal |vauthors=Berg RL, Shaw GR |title=Laboratory evaluation for vitamin B12 deficiency: the case for cascade testing |journal=Clin Med Res |volume=11 |issue=1 |pages=7–15 |date=February 2013 |pmid=23262189 |doi=10.3121/cmr.2012.1112 |url=}}</ref>
* Decreased serum Vitamin B12 levels (< 200 pg/ml)
* Decreased [[serum]] [[Vitamin B12]] levels (< 200 pg/ml)
* Elevated methymalonic acid
* [[Methylmalonic acidemia|Elevated methylmalonic acid]]
*  
*  
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* Serum Vitamin B12 levels<ref name="pmid2339684">{{cite journal |vauthors=Lindenbaum J, Savage DG, Stabler SP, Allen RH |title=Diagnosis of cobalamin deficiency: II. Relative sensitivities of serum cobalamin, methylmalonic acid, and total homocysteine concentrations |journal=Am. J. Hematol. |volume=34 |issue=2 |pages=99–107 |date=June 1990 |pmid=2339684 |doi= |url=}}</ref>
* [[Serum]] [[Vitamin B12]] levels<ref name="pmid2339684">{{cite journal |vauthors=Lindenbaum J, Savage DG, Stabler SP, Allen RH |title=Diagnosis of cobalamin deficiency: II. Relative sensitivities of serum cobalamin, methylmalonic acid, and total homocysteine concentrations |journal=Am. J. Hematol. |volume=34 |issue=2 |pages=99–107 |date=June 1990 |pmid=2339684 |doi= |url=}}</ref>
* Methymalonic acid levels
* [[Methylmalonic acid|Methylmalonic acid levels]]
* Intrinsic factor antibodies<ref name="pmid232621892">{{cite journal |vauthors=Berg RL, Shaw GR |title=Laboratory evaluation for vitamin B12 deficiency: the case for cascade testing |journal=Clin Med Res |volume=11 |issue=1 |pages=7–15 |date=February 2013 |pmid=23262189 |pmc=3573090 |doi=10.3121/cmr.2012.1112 |url=}}</ref>
* [[Intrinsic factor|Intrinsic factor antibodies]]<ref name="pmid232621892">{{cite journal |vauthors=Berg RL, Shaw GR |title=Laboratory evaluation for vitamin B12 deficiency: the case for cascade testing |journal=Clin Med Res |volume=11 |issue=1 |pages=7–15 |date=February 2013 |pmid=23262189 |pmc=3573090 |doi=10.3121/cmr.2012.1112 |url=}}</ref>


*
*
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* Vitamin B12 supplement (parenteral)<ref name="pmid12086562">{{cite journal |vauthors=Lane LA, Rojas-Fernandez C |title=Treatment of vitamin b(12)-deficiency anemia: oral versus parenteral therapy |journal=Ann Pharmacother |volume=36 |issue=7-8 |pages=1268–72 |date=2002 |pmid=12086562 |doi=10.1345/aph.1A122 |url=}}</ref>
* [[Vitamin B12]] supplement ([[parenteral]])<ref name="pmid12086562">{{cite journal |vauthors=Lane LA, Rojas-Fernandez C |title=Treatment of vitamin b(12)-deficiency anemia: oral versus parenteral therapy |journal=Ann Pharmacother |volume=36 |issue=7-8 |pages=1268–72 |date=2002 |pmid=12086562 |doi=10.1345/aph.1A122 |url=}}</ref>
|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Guillain-Barre Syndrome (Demyelinating)'''<ref name="pmid117249122">{{cite journal |vauthors=Winer JB |title=Guillain Barré syndrome |journal=MP, Mol. Pathol. |volume=54 |issue=6 |pages=381–5 |date=December 2001 |pmid=11724912 |pmc=1187127 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Guillain-Barré syndrome|Guillain-Barre Syndrome]] (Demyelinating)'''<ref name="pmid117249122">{{cite journal |vauthors=Winer JB |title=Guillain Barré syndrome |journal=MP, Mol. Pathol. |volume=54 |issue=6 |pages=381–5 |date=December 2001 |pmid=11724912 |pmc=1187127 |doi= |url=}}</ref>
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* Anti-ganglioside and anti-myelin antibodies<ref name="pmid7486873">{{cite journal |vauthors=Rees JH, Gregson NA, Hughes RA |title=Anti-ganglioside GM1 antibodies in Guillain-Barré syndrome and their relationship to Campylobacter jejuni infection |journal=Ann. Neurol. |volume=38 |issue=5 |pages=809–16 |date=November 1995 |pmid=7486873 |doi=10.1002/ana.410380516 |url=}}</ref>
* Anti-ganglioside and anti-myelin antibodies<ref name="pmid7486873">{{cite journal |vauthors=Rees JH, Gregson NA, Hughes RA |title=Anti-ganglioside GM1 antibodies in Guillain-Barré syndrome and their relationship to Campylobacter jejuni infection |journal=Ann. Neurol. |volume=38 |issue=5 |pages=809–16 |date=November 1995 |pmid=7486873 |doi=10.1002/ana.410380516 |url=}}</ref>
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* DVT/PE prevention
* DVT/PE prevention
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) (Mixed axonal and demyelinatiing)'''<ref name="urlChronic Inflammatory Demyelinating Polyradiculoneuropathy: Clinical Characteristics, Course, and Recommendations for Diagnostic Criteria | JAMA Neurology | JAMA Network">{{cite web |url=https://jamanetwork.com/journals/jamaneurology/article-abstract/589258 |title=Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Clinical Characteristics, Course, and Recommendations for Diagnostic Criteria &#124; JAMA Neurology &#124; JAMA Network |format= |work= |accessdate=}}</ref><ref name="urlonlinelibrary.wiley.com2">{{cite web |url=https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-1331.2009.02930.x |title=onlinelibrary.wiley.com |format= |work= |accessdate=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Chronic inflammatory demyelinating polyneuropathy|Chronic Inflammatory Demyelinating Polyneuropathy]] (CIDP) (Mixed axonal and demyelinatiing)'''<ref name="urlChronic Inflammatory Demyelinating Polyradiculoneuropathy: Clinical Characteristics, Course, and Recommendations for Diagnostic Criteria | JAMA Neurology | JAMA Network">{{cite web |url=https://jamanetwork.com/journals/jamaneurology/article-abstract/589258 |title=Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Clinical Characteristics, Course, and Recommendations for Diagnostic Criteria &#124; JAMA Neurology &#124; JAMA Network |format= |work= |accessdate=}}</ref><ref name="urlonlinelibrary.wiley.com2">{{cite web |url=https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-1331.2009.02930.x |title=onlinelibrary.wiley.com |format= |work= |accessdate=}}</ref>
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* Abnormal immune (both IgG based humoral and T-Cell mediated) response to unknown antigen (possible culprits include myelin proteins P0, P2 and PMP22)<ref name="pmid2440998">{{cite journal |vauthors=Milner P, Lovelidge CA, Taylor WA, Hughes RA |title=P0 myelin protein produces experimental allergic neuritis in Lewis rats |journal=J. Neurol. Sci. |volume=79 |issue=3 |pages=275–85 |date=July 1987 |pmid=2440998 |doi= |url=}}</ref><ref name="pmid10713353">{{cite journal |vauthors=Gabriel CM, Gregson NA, Hughes RA |title=Anti-PMP22 antibodies in patients with inflammatory neuropathy |journal=J. Neuroimmunol. |volume=104 |issue=2 |pages=139–46 |date=May 2000 |pmid=10713353 |doi= |url=}}</ref><ref name="pmid10025777">{{cite journal |vauthors=Bouchard C, Lacroix C, Planté V, Adams D, Chedru F, Guglielmi JM, Said G |title=Clinicopathologic findings and prognosis of chronic inflammatory demyelinating polyneuropathy |journal=Neurology |volume=52 |issue=3 |pages=498–503 |date=February 1999 |pmid=10025777 |doi= |url=}}</ref>
* Abnormal immune (both IgG based humoral and T-Cell mediated) response to unknown antigen (possible culprits include myelin proteins P0, P2 and PMP22)<ref name="pmid2440998">{{cite journal |vauthors=Milner P, Lovelidge CA, Taylor WA, Hughes RA |title=P0 myelin protein produces experimental allergic neuritis in Lewis rats |journal=J. Neurol. Sci. |volume=79 |issue=3 |pages=275–85 |date=July 1987 |pmid=2440998 |doi= |url=}}</ref><ref name="pmid10713353">{{cite journal |vauthors=Gabriel CM, Gregson NA, Hughes RA |title=Anti-PMP22 antibodies in patients with inflammatory neuropathy |journal=J. Neuroimmunol. |volume=104 |issue=2 |pages=139–46 |date=May 2000 |pmid=10713353 |doi= |url=}}</ref><ref name="pmid10025777">{{cite journal |vauthors=Bouchard C, Lacroix C, Planté V, Adams D, Chedru F, Guglielmi JM, Said G |title=Clinicopathologic findings and prognosis of chronic inflammatory demyelinating polyneuropathy |journal=Neurology |volume=52 |issue=3 |pages=498–503 |date=February 1999 |pmid=10025777 |doi= |url=}}</ref>
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* Imuunosupressants (Alemtuzemab Azathioprine Cyclophosphamide Cyclosporin Etanercept Interferon-alpha)
* Imuunosupressants (Alemtuzemab Azathioprine Cyclophosphamide Cyclosporin Etanercept Interferon-alpha)
|-
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Multifocal Motor Neuropathy'''<ref name="RobbinsLawson2018">{{cite journal|last1=Robbins|first1=Nathaniel M|last2=Lawson|first2=Victoria|title=The Potential Misdiagnosis of Multifocal Motor Neuropathy as Amyotrophic Lateral Sclerosis—A Case Series|journal=US Neurology|volume=14|issue=2|year=2018|pages=102|issn=1758-4000|doi=10.17925/USN.2018.14.2.102}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Multifocal motor neuropathy|Multifocal Motor Neuropathy]]'''<ref name="RobbinsLawson2018">{{cite journal|last1=Robbins|first1=Nathaniel M|last2=Lawson|first2=Victoria|title=The Potential Misdiagnosis of Multifocal Motor Neuropathy as Amyotrophic Lateral Sclerosis—A Case Series|journal=US Neurology|volume=14|issue=2|year=2018|pages=102|issn=1758-4000|doi=10.17925/USN.2018.14.2.102}}</ref>
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* Abnormal immune response (Anti ganglioside GM-1 IgM antibodies)
* Abnormal immune response (Anti ganglioside GM-1 IgM antibodies)
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| colspan="2" rowspan="7" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''O = Organomegaly (Hepatosplenomegaly and Lymphadenopathy)'''''
| colspan="2" rowspan="7" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''O = Organomegaly (Hepatosplenomegaly and Lymphadenopathy)'''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Malaria'''<ref name="pmid22708041">{{cite journal |vauthors=Bartoloni A, Zammarchi L |title=Clinical aspects of uncomplicated and severe malaria |journal=Mediterr J Hematol Infect Dis |volume=4 |issue=1 |pages=e2012026 |date=2012 |pmid=22708041 |doi=10.4084/MJHID.2012.026 |url=}}</ref><ref name="pmid19488414">{{cite journal |vauthors=Tangpukdee N, Duangdee C, Wilairatana P, Krudsood S |title=Malaria diagnosis: a brief review |journal=Korean J. Parasitol. |volume=47 |issue=2 |pages=93–102 |date=June 2009 |pmid=19488414 |doi=10.3347/kjp.2009.47.2.93 |url=}}</ref><ref name="pmid8703186">{{cite journal |vauthors=White NJ |title=The treatment of malaria |journal=N. Engl. J. Med. |volume=335 |issue=11 |pages=800–6 |date=September 1996 |pmid=8703186 |doi=10.1056/NEJM199609123351107 |url=}}</ref>  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Malaria]]'''<ref name="pmid22708041">{{cite journal |vauthors=Bartoloni A, Zammarchi L |title=Clinical aspects of uncomplicated and severe malaria |journal=Mediterr J Hematol Infect Dis |volume=4 |issue=1 |pages=e2012026 |date=2012 |pmid=22708041 |doi=10.4084/MJHID.2012.026 |url=}}</ref><ref name="pmid19488414">{{cite journal |vauthors=Tangpukdee N, Duangdee C, Wilairatana P, Krudsood S |title=Malaria diagnosis: a brief review |journal=Korean J. Parasitol. |volume=47 |issue=2 |pages=93–102 |date=June 2009 |pmid=19488414 |doi=10.3347/kjp.2009.47.2.93 |url=}}</ref><ref name="pmid8703186">{{cite journal |vauthors=White NJ |title=The treatment of malaria |journal=N. Engl. J. Med. |volume=335 |issue=11 |pages=800–6 |date=September 1996 |pmid=8703186 |doi=10.1056/NEJM199609123351107 |url=}}</ref>  
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Plasmodium falciparum
* Plasmodium falciparum
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** Atovaquone plus proguanil
** Atovaquone plus proguanil
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Kala-azar'''<ref name="pmid10798038">{{cite journal |vauthors=Aggarwal P, Handa R, Singh S, Wali JP |title=Kala-azar--new developments in diagnosis and treatment |journal=Indian J Pediatr |volume=66 |issue=1 |pages=63–71 |date=1999 |pmid=10798038 |doi= |url=}}</ref><ref name="pmid28649370">{{cite journal |vauthors=Torres-Guerrero E, Quintanilla-Cedillo MR, Ruiz-Esmenjaud J, Arenas R |title=Leishmaniasis: a review |journal=F1000Res |volume=6 |issue= |pages=750 |date=2017 |pmid=28649370 |doi=10.12688/f1000research.11120.1 |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Kala-azar]]'''<ref name="pmid10798038">{{cite journal |vauthors=Aggarwal P, Handa R, Singh S, Wali JP |title=Kala-azar--new developments in diagnosis and treatment |journal=Indian J Pediatr |volume=66 |issue=1 |pages=63–71 |date=1999 |pmid=10798038 |doi= |url=}}</ref><ref name="pmid28649370">{{cite journal |vauthors=Torres-Guerrero E, Quintanilla-Cedillo MR, Ruiz-Esmenjaud J, Arenas R |title=Leishmaniasis: a review |journal=F1000Res |volume=6 |issue= |pages=750 |date=2017 |pmid=28649370 |doi=10.12688/f1000research.11120.1 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Leshmania donovani
* Leshmania donovani
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* Pentamidine
* Pentamidine
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Infective Hepatitis'''<ref name="pmid19399811">{{cite journal |vauthors=Liang TJ |title=Hepatitis B: the virus and disease |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S13–21 |date=May 2009 |pmid=19399811 |pmc=2809016 |doi=10.1002/hep.22881 |url=}}</ref><ref name="pmid26052383">{{cite journal |vauthors=Li HC, Lo SY |title=Hepatitis C virus: Virology, diagnosis and treatment |journal=World J Hepatol |volume=7 |issue=10 |pages=1377–89 |date=June 2015 |pmid=26052383 |pmc=4450201 |doi=10.4254/wjh.v7.i10.1377 |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Hepatitis|Infective Hepatitis]]'''<ref name="pmid19399811">{{cite journal |vauthors=Liang TJ |title=Hepatitis B: the virus and disease |journal=Hepatology |volume=49 |issue=5 Suppl |pages=S13–21 |date=May 2009 |pmid=19399811 |pmc=2809016 |doi=10.1002/hep.22881 |url=}}</ref><ref name="pmid26052383">{{cite journal |vauthors=Li HC, Lo SY |title=Hepatitis C virus: Virology, diagnosis and treatment |journal=World J Hepatol |volume=7 |issue=10 |pages=1377–89 |date=June 2015 |pmid=26052383 |pmc=4450201 |doi=10.4254/wjh.v7.i10.1377 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Hepatitis A virus (HAV)
* Hepatitis A virus (HAV)
Line 285: Line 285:
* [[Antivirals|Nucleotide analogs]]
* [[Antivirals|Nucleotide analogs]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Chronic Myelogenous Leukemia (CML)'''<ref name="cancergov">National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/types/leukemia/hp/cml-treatment-pdq#section/_19</ref><ref name="pmid24729196">{{cite journal |vauthors=Jabbour E, Kantarjian H |title=Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management |journal=Am. J. Hematol. |volume=89 |issue=5 |pages=547–56 |date=May 2014 |pmid=24729196 |doi=10.1002/ajh.23691 |url=}}</ref><ref name="pmid26434969">{{cite journal |vauthors=Thompson PA, Kantarjian HM, Cortes JE |title=Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015 |journal=Mayo Clin. Proc. |volume=90 |issue=10 |pages=1440–54 |date=October 2015 |pmid=26434969 |pmc=5656269 |doi=10.1016/j.mayocp.2015.08.010 |url=}}</ref><ref name="pmid10428738">{{cite journal |vauthors=Faderl S, Talpaz M, Estrov Z, Kantarjian HM |title=Chronic myelogenous leukemia: biology and therapy |journal=Ann. Intern. Med. |volume=131 |issue=3 |pages=207–19 |date=August 1999 |pmid=10428738 |doi= |url=}}</ref><ref name="cancer.ca">Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/treatment/chronic/?region=ab</ref><ref name="Tefferi">{{cite journal|title=Classification, diagnosis and management of myeloproliferative disorders in the JAK2V617F era|author=Tefferi A|journal=Hematology Am Soc Hematol Educ Program|date=2006|pages=240-245|pmid=17124067}}</ref><ref name="cancer.ca2">Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/signs-and-symptoms/?region=ab</ref><ref name="pmid264349692">{{cite journal |vauthors=Thompson PA, Kantarjian HM, Cortes JE |title=Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015 |journal=Mayo Clin. Proc. |volume=90 |issue=10 |pages=1440–54 |date=October 2015 |pmid=26434969 |pmc=5656269 |doi=10.1016/j.mayocp.2015.08.010 |url=}}</ref><ref name="pmid11550277">{{cite journal |vauthors=Wang YL, Bagg A, Pear W, Nowell PC, Hess JL |title=Chronic myelogenous leukemia: laboratory diagnosis and monitoring |journal=Genes Chromosomes Cancer |volume=32 |issue=2 |pages=97–111 |date=October 2001 |pmid=11550277 |doi= |url=}}</ref><ref name="pmid264349692">{{cite journal |vauthors=Thompson PA, Kantarjian HM, Cortes JE |title=Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015 |journal=Mayo Clin. Proc. |volume=90 |issue=10 |pages=1440–54 |date=October 2015 |pmid=26434969 |pmc=5656269 |doi=10.1016/j.mayocp.2015.08.010 |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Chronic myelogenous leukemia|Chronic Myelogenous Leukemia]] (CML)'''<ref name="cancergov">National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/types/leukemia/hp/cml-treatment-pdq#section/_19</ref><ref name="pmid24729196">{{cite journal |vauthors=Jabbour E, Kantarjian H |title=Chronic myeloid leukemia: 2014 update on diagnosis, monitoring, and management |journal=Am. J. Hematol. |volume=89 |issue=5 |pages=547–56 |date=May 2014 |pmid=24729196 |doi=10.1002/ajh.23691 |url=}}</ref><ref name="pmid26434969">{{cite journal |vauthors=Thompson PA, Kantarjian HM, Cortes JE |title=Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015 |journal=Mayo Clin. Proc. |volume=90 |issue=10 |pages=1440–54 |date=October 2015 |pmid=26434969 |pmc=5656269 |doi=10.1016/j.mayocp.2015.08.010 |url=}}</ref><ref name="pmid10428738">{{cite journal |vauthors=Faderl S, Talpaz M, Estrov Z, Kantarjian HM |title=Chronic myelogenous leukemia: biology and therapy |journal=Ann. Intern. Med. |volume=131 |issue=3 |pages=207–19 |date=August 1999 |pmid=10428738 |doi= |url=}}</ref><ref name="cancer.ca">Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/treatment/chronic/?region=ab</ref><ref name="Tefferi">{{cite journal|title=Classification, diagnosis and management of myeloproliferative disorders in the JAK2V617F era|author=Tefferi A|journal=Hematology Am Soc Hematol Educ Program|date=2006|pages=240-245|pmid=17124067}}</ref><ref name="cancer.ca2">Canadian Cancer Society.2015.http://www.cancer.ca/en/cancer-information/cancer-type/leukemia-chronic-myelogenous-cml/signs-and-symptoms/?region=ab</ref><ref name="pmid264349692">{{cite journal |vauthors=Thompson PA, Kantarjian HM, Cortes JE |title=Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015 |journal=Mayo Clin. Proc. |volume=90 |issue=10 |pages=1440–54 |date=October 2015 |pmid=26434969 |pmc=5656269 |doi=10.1016/j.mayocp.2015.08.010 |url=}}</ref><ref name="pmid11550277">{{cite journal |vauthors=Wang YL, Bagg A, Pear W, Nowell PC, Hess JL |title=Chronic myelogenous leukemia: laboratory diagnosis and monitoring |journal=Genes Chromosomes Cancer |volume=32 |issue=2 |pages=97–111 |date=October 2001 |pmid=11550277 |doi= |url=}}</ref><ref name="pmid264349692">{{cite journal |vauthors=Thompson PA, Kantarjian HM, Cortes JE |title=Diagnosis and Treatment of Chronic Myeloid Leukemia in 2015 |journal=Mayo Clin. Proc. |volume=90 |issue=10 |pages=1440–54 |date=October 2015 |pmid=26434969 |pmc=5656269 |doi=10.1016/j.mayocp.2015.08.010 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* BCR/ABL gene fusion product due to translocation mutation t(9;22)(q34;q11)<ref name="pmid23147546">{{cite journal |vauthors=Zahra K, Ben Fredj W, Ben Youssef Y, Zaghouani H, Chebchoub I, Zaier M, Badreddine S, Braham N, Sennana H, Khelif A |title=Chronic myeloid leukemia as a secondary malignancy after lymphoma in a child. A case report and review of the literature |journal=Onkologie |volume=35 |issue=11 |pages=690–3 |date=2012 |pmid=23147546 |doi=10.1159/000343952 |url=}}</ref>
* BCR/ABL gene fusion product due to translocation mutation t(9;22)(q34;q11)<ref name="pmid23147546">{{cite journal |vauthors=Zahra K, Ben Fredj W, Ben Youssef Y, Zaghouani H, Chebchoub I, Zaier M, Badreddine S, Braham N, Sennana H, Khelif A |title=Chronic myeloid leukemia as a secondary malignancy after lymphoma in a child. A case report and review of the literature |journal=Onkologie |volume=35 |issue=11 |pages=690–3 |date=2012 |pmid=23147546 |doi=10.1159/000343952 |url=}}</ref>
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Lymphoma'''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Lymphoma]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Various causes based on type:
* Various causes based on type:
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| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Primary (AL) Amyloidosis'''<ref name="pmid25378951">{{cite journal |vauthors=Real de Asúa D, Costa R, Galván JM, Filigheddu MT, Trujillo D, Cadiñanos J |title=Systemic AA amyloidosis: epidemiology, diagnosis, and management |journal=Clin Epidemiol |volume=6 |issue= |pages=369–77 |date=2014 |pmid=25378951 |pmc=4218891 |doi=10.2147/CLEP.S39981 |url=}}</ref><ref name="pmid24998818">{{cite journal |vauthors=Misumi Y, Ando Y |title=[Classification of amyloidosis] |language=Japanese |journal=Brain Nerve |volume=66 |issue=7 |pages=731–7 |date=July 2014 |pmid=24998818 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Primary amyloidosis|Primary (AL) Amyloidosis]]'''<ref name="pmid25378951">{{cite journal |vauthors=Real de Asúa D, Costa R, Galván JM, Filigheddu MT, Trujillo D, Cadiñanos J |title=Systemic AA amyloidosis: epidemiology, diagnosis, and management |journal=Clin Epidemiol |volume=6 |issue= |pages=369–77 |date=2014 |pmid=25378951 |pmc=4218891 |doi=10.2147/CLEP.S39981 |url=}}</ref><ref name="pmid24998818">{{cite journal |vauthors=Misumi Y, Ando Y |title=[Classification of amyloidosis] |language=Japanese |journal=Brain Nerve |volume=66 |issue=7 |pages=731–7 |date=July 2014 |pmid=24998818 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Aggregation and deposition of immunoglobulin light chains that usually produced by plasma cell clones<ref name="pmid21360109">{{cite journal |vauthors=Bilginer Y, Akpolat T, Ozen S |title=Renal amyloidosis in children |journal=Pediatr. Nephrol. |volume=26 |issue=8 |pages=1215–27 |date=August 2011 |pmid=21360109 |pmc=3119800 |doi=10.1007/s00467-011-1797-x |url=}}</ref><ref name="pmid28134587">{{cite journal |vauthors=Khoor A, Colby TV |title=Amyloidosis of the Lung |journal=Arch. Pathol. Lab. Med. |volume=141 |issue=2 |pages=247–254 |date=February 2017 |pmid=28134587 |doi=10.5858/arpa.2016-0102-RA |url=}}</ref>
* Aggregation and deposition of immunoglobulin light chains that usually produced by plasma cell clones<ref name="pmid21360109">{{cite journal |vauthors=Bilginer Y, Akpolat T, Ozen S |title=Renal amyloidosis in children |journal=Pediatr. Nephrol. |volume=26 |issue=8 |pages=1215–27 |date=August 2011 |pmid=21360109 |pmc=3119800 |doi=10.1007/s00467-011-1797-x |url=}}</ref><ref name="pmid28134587">{{cite journal |vauthors=Khoor A, Colby TV |title=Amyloidosis of the Lung |journal=Arch. Pathol. Lab. Med. |volume=141 |issue=2 |pages=247–254 |date=February 2017 |pmid=28134587 |doi=10.5858/arpa.2016-0102-RA |url=}}</ref>
Line 372: Line 372:
* Stem cell transplantation<ref name="pmid14734330">{{cite journal |vauthors=Skinner M, Sanchorawala V, Seldin DC, Dember LM, Falk RH, Berk JL, Anderson JJ, O'Hara C, Finn KT, Libbey CA, Wiesman J, Quillen K, Swan N, Wright DG |title=High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: an 8-year study |journal=Ann. Intern. Med. |volume=140 |issue=2 |pages=85–93 |date=January 2004 |pmid=14734330 |doi= |url=}}</ref>
* Stem cell transplantation<ref name="pmid14734330">{{cite journal |vauthors=Skinner M, Sanchorawala V, Seldin DC, Dember LM, Falk RH, Berk JL, Anderson JJ, O'Hara C, Finn KT, Libbey CA, Wiesman J, Quillen K, Swan N, Wright DG |title=High-dose melphalan and autologous stem-cell transplantation in patients with AL amyloidosis: an 8-year study |journal=Ann. Intern. Med. |volume=140 |issue=2 |pages=85–93 |date=January 2004 |pmid=14734330 |doi= |url=}}</ref>
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Gaucher's Disease'''<ref name="pmid28218669">{{cite journal |vauthors=Stirnemann J, Belmatoug N, Camou F, Serratrice C, Froissart R, Caillaud C, Levade T, Astudillo L, Serratrice J, Brassier A, Rose C, Billette de Villemeur T, Berger MG |title=A Review of Gaucher Disease Pathophysiology, Clinical Presentation and Treatments |journal=Int J Mol Sci |volume=18 |issue=2 |pages= |date=February 2017 |pmid=28218669 |doi=10.3390/ijms18020441 |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Gaucher's disease|Gaucher's Disease]]'''<ref name="pmid28218669">{{cite journal |vauthors=Stirnemann J, Belmatoug N, Camou F, Serratrice C, Froissart R, Caillaud C, Levade T, Astudillo L, Serratrice J, Brassier A, Rose C, Billette de Villemeur T, Berger MG |title=A Review of Gaucher Disease Pathophysiology, Clinical Presentation and Treatments |journal=Int J Mol Sci |volume=18 |issue=2 |pages= |date=February 2017 |pmid=28218669 |doi=10.3390/ijms18020441 |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* GBA gene mutation
* GBA gene mutation
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| rowspan="7" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''E = Endocrinopathy (Hypogonadism, Hypothyroidism, Hypopituitarism)'''''
| rowspan="7" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''E = Endocrinopathy (Hypogonadism, Hypothyroidism, Hypopituitarism)'''''
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Hypogonadism<ref name="pmid16985909">{{cite journal |vauthors=Carnegie C |title=Diagnosis of hypogonadism: clinical assessments and laboratory tests |journal=Rev Urol |volume=6 Suppl 6 |issue= |pages=S3–8 |date=2004 |pmid=16985909 |pmc=1472884 |doi= |url=}}</ref><ref name="pmid20518947">{{cite journal |vauthors=Dandona P, Rosenberg MT |title=A practical guide to male hypogonadism in the primary care setting |journal=Int. J. Clin. Pract. |volume=64 |issue=6 |pages=682–96 |date=May 2010 |pmid=20518947 |doi=10.1111/j.1742-1241.2010.02355.x |url=}}</ref>
| rowspan="2" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Hypogonadism<ref name="pmid16985909">{{cite journal |vauthors=Carnegie C |title=Diagnosis of hypogonadism: clinical assessments and laboratory tests |journal=Rev Urol |volume=6 Suppl 6 |issue= |pages=S3–8 |date=2004 |pmid=16985909 |pmc=1472884 |doi= |url=}}</ref><ref name="pmid20518947">{{cite journal |vauthors=Dandona P, Rosenberg MT |title=A practical guide to male hypogonadism in the primary care setting |journal=Int. J. Clin. Pract. |volume=64 |issue=6 |pages=682–96 |date=May 2010 |pmid=20518947 |doi=10.1111/j.1742-1241.2010.02355.x |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Primary Hypogonadism (Hypergonadotrophic)'''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Hypogonadism|Primary Hypogonadism]] (Hypergonadotrophic)'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Klinefelter's syndrome
* Klinefelter's syndrome
Line 450: Line 450:
* Hormone replacement therapy
* Hormone replacement therapy
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Secondary Hypogonadism (Hypogonadotrophic)'''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Hypogonadism|Secondary Hypogonadism]] (Hypogonadotrophic)'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Panhypopituitarism
* Panhypopituitarism
Line 472: Line 472:
|-
|-
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Hypothyroidism<ref name="pmid20596261">{{cite journal |vauthors=Kostoglou-Athanassiou I, Ntalles K |title=Hypothyroidism - new aspects of an old disease |journal=Hippokratia |volume=14 |issue=2 |pages=82–7 |date=April 2010 |pmid=20596261 |doi= |url=}}</ref><ref name="pmid24275187">{{cite journal |vauthors=Koulouri O, Moran C, Halsall D, Chatterjee K, Gurnell M |title=Pitfalls in the measurement and interpretation of thyroid function tests |journal=Best Pract. Res. Clin. Endocrinol. Metab. |volume=27 |issue=6 |pages=745–62 |date=December 2013 |pmid=24275187 |doi=10.1016/j.beem.2013.10.003 |url=}}</ref>
| rowspan="3" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Hypothyroidism<ref name="pmid20596261">{{cite journal |vauthors=Kostoglou-Athanassiou I, Ntalles K |title=Hypothyroidism - new aspects of an old disease |journal=Hippokratia |volume=14 |issue=2 |pages=82–7 |date=April 2010 |pmid=20596261 |doi= |url=}}</ref><ref name="pmid24275187">{{cite journal |vauthors=Koulouri O, Moran C, Halsall D, Chatterjee K, Gurnell M |title=Pitfalls in the measurement and interpretation of thyroid function tests |journal=Best Pract. Res. Clin. Endocrinol. Metab. |volume=27 |issue=6 |pages=745–62 |date=December 2013 |pmid=24275187 |doi=10.1016/j.beem.2013.10.003 |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Primary Hypothyroidism
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Primary hypothyroidism|Primary Hypothyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Congenital hypothyroidism
* Congenital hypothyroidism
Line 520: Line 520:
* Hormone replacement therapy
* Hormone replacement therapy
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Secondary Hypothyroidism
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Secondary hypothyroidism|Secondary Hypothyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Pituitary mass lesions, especially pituitary adenomas
* Pituitary mass lesions, especially pituitary adenomas
Line 536: Line 536:
* Decreased TSH
* Decreased TSH
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Tertiary Hypothyroidism
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Tertiary hypothyroidism|Tertiary Hypothyroidism]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* Hemochromatosis
* Hemochromatosis
Line 660: Line 660:
* Observation
* Observation
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Asymptomatic Plasma Cell Myeloma'''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Multiple Myeloma|Asymptomatic Plasma Cell Myeloma]]'''
('''Smoldering''' and '''Indolent plasma cell myeloma''')
[[Multiple Myeloma|('''Smoldering''' and '''Indolent plasma cell myeloma''')]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
*[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
Line 702: Line 702:
* Radiotherapy
* Radiotherapy
|-
|-
| colspan="2" rowspan="3" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Bone Lesions
| colspan="2" rowspan="3" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Bone Lesions
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteoporosis]]'''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteoporosis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Line 766: Line 766:
*Genetic counseling for offspring
*Genetic counseling for offspring
|-
|-
| colspan="2" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Skin Changes
| colspan="2" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Skin Changes
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Scurvy]]'''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Scurvy]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
Line 783: Line 783:
*[[Vitamin C]] supplementation
*[[Vitamin C]] supplementation
*Citrus fruits
*Citrus fruits
|-
|
|
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Homocystinuria]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Deficiency of [[Cystathionine-beta-synthase|cystathionine ''beta'' synthase]]
*Deficiency of [[folate]], [[vitamin B12]], or [[vitamin B6]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Diffuse [[bone]] [[pain]] and [[musculoskeletal]] symptoms
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*High-dose [[vitamin B6]] supplementation
*[[Betaine]] supplementation
|}
|}


Revision as of 15:53, 18 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

The diagnosis of POEMS syndrome presents a diagnostic challenge for the physician. A thorough examination of organ systems should be attempted in order to reach a confirmed diagnosis. POEMS syndrome should be differentiated from other conditions presenting as a polyneuropathy (metabolic syndrome, vitamin B12 deficiency, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and multifocal motor polyneuropathy), organomegaly with lymphadenopathy (malaria, leshmaniasis or kala-azar, infective hepatitis, chronic myelogenous leukemia, lymphoma, primary amyloidosis, Gaucher's disease), endocrinopathy (hypogonadism, hypothyroidism, hypopituitarism), monoclonal plasma cell proliferation (multiple myeloma, monoclonal gammopathy of undetermined significance, plasmacytoma), mixed lytic/sclerotic bone lesions (osteomalacia, osteogenesis imperfecta) and skin changes.

Differentiating POEMS Syndrome From Other Diseases

The diagnosis of POEMS syndrome presents a diagnostic challenge for the physician. A thorough examination of organ systems should be attempted in order to reach a confirmed diagnosis. POEMS syndrome should be differentiated from other conditions presenting as a polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell proliferation, mixed lytic/sclerotic bone lesions and skin changes. The differentials include the following:

Organ System Involvement Differential Diagnosis Causes Clinical Features Laboratory Findings Gold Standard Test Therapy
P = Polyneuropathy POEMS syndrome (Demyelinating)[1]
Metabolic Syndrome (Axonal pathology)[8]
Vitamin Deficiencies (Axonal Pathology)[10]
Guillain-Barre Syndrome (Demyelinating)[16]
  • Anti-ganglioside and anti-myelin antibodies[17]
  • Viral infections:[18]
    • Epstein Barr virus
    • HIV
    • Cytomegalovirus
    • Varicella Zoster virus
  • Bacterial infections:[19]
    • Campylobacter infection
    • Mycoplasma pneumoniae
  • Rapid onset and quick progression
  • Progression stops after 2-3 weeks
  • Bilateral ascending paraesthesias and paralysis (generalized)
  • Weakness
  • Ataxia
  • Areflexia
  • No fever
  • 4 sub-types:
    • Acute inflammatory demyelinating polyneuropathy
    • Acute motor axonal neuropathy
    • Acute motor and sensory axonal neuropathy
    • Miller Fisher syndrome
  • Clinical diagnostic criteria (progressive weakness of more than two limbs, areflexia, and progression for no more than four weeks)[21]
  • Intravenous immunoglobulins[22]
  • Plasma exchange[23]
  • Respiratory support
  • DVT/PE prevention
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) (Mixed axonal and demyelinatiing)[24][25]
  • Abnormal immune (both IgG based humoral and T-Cell mediated) response to unknown antigen (possible culprits include myelin proteins P0, P2 and PMP22)[26][27][28]
  • Slow onset and gradual progression
  • Relapsing and remitting course
  • Symmetrical proximal and distal motor and sensory weakness (legs>arms)
  • Foot drop
  • Numbness, tingling and pain
  • Areflexia
  • Elevated CSF protein (oligoclonal bands with normal WBCs)[29]
  • Slowed motor nerve conduction velocities[30]
  • Prolonged distal motor latencies (period between F wave and initial stimulation)
  • Delayed F wave latencies (recorded from the feet, hence called "F" waves)[31]
  • MRI contrast enhancement and enlargement of T2 spinal segments[32]
  • EFNS/PNS criteria[33]
  • Koski criteria[34]
  • Corticosteroids
  • Intravenous immunoglobulin (IVIG)
  • Imuunosupressants (Alemtuzemab Azathioprine Cyclophosphamide Cyclosporin Etanercept Interferon-alpha)
Multifocal Motor Neuropathy[35]
  • Abnormal immune response (Anti ganglioside GM-1 IgM antibodies)
  • Progressive, asymmetric, distal and upper limb predominant weakness
  • No significant sensory abnormalities
  • Areflexia
  • Elevated CSF protein
  • Clinical criteria (EFNS/PNS):[36]
    • Slowly progressive or stepwise progressive, focal, asymmetric limb weakness; i.e., motor involvement in the motor nerve distribution of at least two nerves for > 1 month.
    • No objective sensory abnormalities except for minor vibration sense abnormalities in the lower limbs
  • Intravenous immunoglobilins
  • Cyclophosphamide
  • Rituximab
Organ System Involvement Differential Diagnosis Causes Features Laboratory Findings Gold Standard Test Therapy
O = Organomegaly (Hepatosplenomegaly and Lymphadenopathy) Malaria[37][38][39]
  • Plasmodium falciparum
  • P. ovale
  • P. malariae
  • P. knowlesi
  • Tertian (vivax, ovale, falciparum), quartan (malariae), quotidian fever (knowlesi)
  • Vector is female Anopheles mosquito
  • Hepatosplenomegaly
  • Lymphadenopathy
  • Jaundice
  • Icterus
  • Tachycardia
  • Tachypnea
  • Productive cough
  • Hemeturia
  • Altered mental status
  • Microcytic anemia
  • Thick and thin blood films (Giemsa staining)
  • Rapid diagnostic test (antigen detection
  • Polymerase chain reaction (PCR)
  • Enzyme linked immunosorbent assay (ELISA)
  • Thick and thin films
  • Non-falciparum species:
    • Choloroquine (in susceptible)
    • Artemisinin plus mefloquin or lumefantrine (in chloroquine resistant)
  • Falciparum species:
    • Chloroquine (in susceptible)
    • Artemether plus lumefantrine (in chloroquin resistant) OR
    • Artesunate plus mefloquin OR
    • Artesunate plus sulfadoxine-pyrimethamine
    • Atovaquone plus proguanil
Kala-azar[40][41]
  • Leshmania donovani
  • L. infantum
  • L. chagasi
  • Fever
  • Vector is sandfly
  • Hepatosplenomegaly
  • Lymphadenopathy
  • Hyperpigmentation
  • Anemia
  • Direct Agglutination Test (DAT)
  • rk39 dipstick
  • ELISA
  • Splenic aspiration
  • Liposomal amphotericin B
  • Sodium stibogluconate
  • Pentamidine
Infective Hepatitis[42][43]
  • Hepatitis A virus (HAV)
  • HBV
  • HCV
  • HDV (co-infection with HBV)
  • HEV
  • Fever
  • Transmitted via fecal-oral route (HAV, HBV, HDV, HEV), infected sera (HCV), sexual contact with infected individuals
  • Hepatosplenomegaly (may become shrunken in cases of cirrhosis due to chronic infection)
  • Lymphadenopathy
  • Jaundice
  • Palmar erythema
  • Spider angiomata
  • Gynecomastia
  • Arthritis-dermatitis syndrome
  • Antigen and antibody detection
Chronic Myelogenous Leukemia (CML)[44][45][46][47][48][49][50][51][52][51]
  • BCR/ABL gene fusion product due to translocation mutation t(9;22)(q34;q11)[53]
  • Fever
  • Weight loss
  • Hepatosplenomegaly
  • Lymphadenopathy
  • Flouroscent insitu hybridization (FISH)
Lymphoma
  • Various causes based on type:
    • Hodgkin's
    • Non-Hodgkin's
  • Fever
  • Weight loss
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Night sweats, constant fatigue
  • Purplish scaly rash in cases of cutaneous lymphoma
  • Elevated ESR
  • Increased CRP
  • Increased LDH
  • Anemia of chronic disease
  • Lymph node biopsy
Primary (AL) Amyloidosis[54][55]
  • Aggregation and deposition of immunoglobulin light chains that usually produced by plasma cell clones[56][57]
  • Nephrotic syndrome (peripheral edema
  • Restrictive cardiomyopathy (fatigue, dyspnea, syncope)
  • Peripheral neuropathy (numbness, tingling)
  • Hepatomegaly with elevated liver enzymes
  • Macroglossia
  • Purpura
  • Bleeding diathesis
  • Typical green birefringence under polarized light after Congo red staining (appears in red under normal light)
  • Congo red staining
  • Melphalan-prednisone/dexamethasone[58]
  • Dexamethasone plus Cyclophosphamide-thalidomide [59]
  • Stem cell transplantation[60]
Gaucher's Disease[61]
  • GBA gene mutation
  • Aberrant metabolism of glucocerebroside (lipid)
  • Hydrops fetalis
  • Dry, scaly skin (ichthyosis) or other skin abnormalities
  • Hepatosplenomegaly
  • Distinctive facial features
  • Neurological problems
  • Gall stones
  • Growth retardation
  • Hypocholesterolemia
  • Splenic nodules
  • Cytopenias (especially thrombocytopenia)
  • Increased ferritin levels
  • Increased tartarate resistant acid phosphatase (TRAP) levels
  • Enzyme assay for glucocerebrosidase
  • DNA analysis for GBA mutation
  • Enzyme replacement
  • Splenectomy
  • Blood transfusion
Organ System Involvement Differential Diagnosis Causes Features Laboratory Findings Gold Standard Test Therapy
E = Endocrinopathy (Hypogonadism, Hypothyroidism, Hypopituitarism) Hypogonadism[62][63] Primary Hypogonadism (Hypergonadotrophic)
  • Klinefelter's syndrome
  • Myotonic dystrophy
  • Sertoli-cell tumor
  • Enzymatic defects
  • Viral orchitis (mumps)
  • Cryptorchidism
  • Polyglandular autoimmune syndrome
  • Testicular trauma and tumors
  • Polycystic ovarian syndrome
  • Fatigue
  • Decreased libido
  • Delayed secondary sexual characteristics:
    • Absent/scant pubic hair
    • Impotence
    • Erectile dysfunction
    • Amenorrhea
    • Delayed breast development
    • Small testicular size
  • Decreased muscle mass
  • Osteoporosis
  • Depression
  • Infertility
  • Irritability
  • Mood swings
  • Pot belly
  • Weight gain
  • Decreased sex hormone levels:
    • Decreased testosterone
    • Decreased dihydrotestosterone
    • Decreased estrogen
  • Increased gonadrotrpins:
    • Increased LH
    • Increased FSH
  • Serum sex hormone levels
  • Hormone replacement therapy
Secondary Hypogonadism (Hypogonadotrophic)
  • Panhypopituitarism
  • Hyperprolactinemia
  • Isolated gonadotropin deficiency
  • Kallman's syndrome
  • Congenital
  • Prader-Willi syndrome
  • Hemochromatosis
  • Massive obesity
  • Malnutrition
  • Decreased sex hormone levels:
    • Decreased testosterone
    • Decreased dihydrotestosterone
    • Decreased estrogen
  • Decreased gonadrotrpins:
    • Decreased LH
    • Decreased FSH
Hypothyroidism[64][65] Primary Hypothyroidism
  • Congenital hypothyroidism
  • Autoimmune (Hashimoto's) thyroiditis
  • Resistance to TSH
  • Decreased T3 and T4
  • Increased TSH
  • Serum T3, T4, TSH levels
  • Hormone replacement therapy
Secondary Hypothyroidism
  • Pituitary mass lesions, especially pituitary adenomas
  • Brain cysts and abscesses
  • Meningiomas
  • Dysgerminomas
  • Metastatic tumors
  • Craniopharyngiomas
  • Pituitary apoplexy
  • Sheehan syndrome (postpartum pituitary necrosis)
  • Idiopathic isolated TSH deficiency
  • Lymphocytic or granulomatous hypophysitis
  • Decreased T3 and T4
  • Decreased TSH
Tertiary Hypothyroidism
  • Hemochromatosis
  • Histiocytosis
  • Developmental abnormalities
  • Internal carotid aneurysms
  • Idiopathic isolated TRH deficiency
  • Decreased T3 and T4
  • Decreased TRH
  • Decreased TSH
Hypopituitarism[66][67] Congenital
  • Idiopathic
  • Anatomic lesion in sella turcica (Rathke's cyst)
  • CNS malformations:
    • Septo-optic-dysplasia
    • Kallmann syndrome
    • Pituitary stalk interruption syndrome
  • Decreased FSH, LH
  • Decreased TSH
  • Decreased ACTH
  • Decreased GH
  • Decreased ADH
  • Decreased oxytocin
  • Serum hormone levels produced by pituitary
  • Hormone replacement therapy
Acquired
  • Posterior pituitary tumor: astrocytoma, ganglioneuroma
  • Metastatic: breast, lungs, colon, prostate
  • Peripituitary lesions: Craniopharyngioma, meningioma, chordoma, optic nerve glioma
  • Transsphenoidal or transcranial surgery
  • Radiation
  • Traumatic brain injury
  • Sheehan's syndrome
  • Pituitary apoplexy
  • Meningitis
  • Hypophysitis
  • Lymphoma
Organ System Involvement Differential Diagnosis Causes Features Laboratory Findings Gold Standard Test Therapy
M = M-protein ( Hematological Abnormality/Plasma Cell Dyscrasias) Multiple myeloma[68][69][70]
  • Anemia
  • Thrombocytopenia
  • Leukopenia
  • Decreased albumin (reversed albumin:globulin ratio)
  • Increased serum creatinine, urea
  • Hypercalcemia
  • Elevated ESR
  • Normal-low alkaline phosphatase
  • RBC rouleaux formation
  • Bence-Jones proteins in urine
  • Clonal plasma cells on bone marrow exam greater than equal to 10%

AND

  • Any one of the following:
    • Evidence of end-organ damage
    • Hypercalcemia (>11 mg/dl)
    • Renal insufficiency
    • Anemia (Hb < 10 mg/dl)
    • Bone lesions
    • Greater than 1 lesions on MRI
Monoclonal gammopathy of undetermined significance (MGUS)[71]
  • Serum M protein (IgG or IgA) <3g/dl

AND

  • Clonal bone marrow plasma cells < 10%

AND

  • No end-organ damage
  • Observation
Asymptomatic Plasma Cell Myeloma

(Smoldering and Indolent plasma cell myeloma)

  • Serum M protein (IgG or IgA greater than equal to 3 g/dl

OR

  • Urinary M protein greater than equal to 500 mg/24 h

AND/OR

  • Clonal bone marrow plasma cells 10-60%

AND

  • No end-organ damage
  • Observation
Plasmacytoma
  • On biopsy:
    • Solitary infiltrate of clonal plasma cells in bone (SBP) or soft tissue (EMP).
    • No evidence of infiltration by clonal plasma cells.
  • Negative skeletal survey plus MRI/CT spine and pelvis except for the solitary lesion.
  • Lack of hypercalcemia, renal insuffieciency, anemia, multiple bone lesions which would suggest MM
  • Diagnosis of exclusion
  • Radiotherapy
Bone Lesions Osteoporosis
  • Normal serum calcium, phosphate, alkaline phosphatase and parathyroid hormone levels
  • Decreased bone mass
  • T score less than -2.5 on DEXA scan
Osteomalacia[72]
  • Decreased serum calcium
  • Decreased serum phosphate
  • Increased serum alkaline phosphatase
  • Increased serum parathyroid hormone levels
  • Bone biopsy (increased osteoid and decreased calcification)
Osteogenesis imperfecta
  • Normal serum calcium
  • Normal serum phosphate
  • Increased serum alkaline phosphatase
  • DNA analysis
  • Collagen analysis
Skin Changes Scurvy

Other Differentials

POEMS syndrome must also be differentiated from other similar conditions which lead to multiple endocrine disorders such as autoimmune polyendocrine syndrome, Hirata syndrome, Kearns–Sayre syndrome and Wolfram syndromes.[73][74][75][76][77]

Disease Addison's disease Type 1 diabetes mellitus Hypothyroidism Other disorders present
POEMS syndrome + Less common Less common Hypoparathyroidism
Candidiasis
Hypogonadism
APS type 2 + + + Hypogonadism
Malabsorption
APS type 3 - + + Malabsorption
Thymoma + - + Myasthenia gravis
Cushing syndrome
Chromosomal abnormalities
(Turner syndrome,
Down's syndrome) 		- + + Cardiac dysfunction
Kearns–Sayre syndrome - + - Myopathy
Hypoparathyroidism
Hypogonadism
Wolfram syndrome - + - Diabetes insipidus
Optic atrophy
Deafness
POEMS syndrome - + - Polyneuropathy
Hypogonadism
Plasma cell dyscrasias

References

  1. ↑ Gherardi RK, Bélec L, Soubrier M, Malapert D, Zuber M, Viard JP, Intrator L, Degos JD, Authier FJ (February 1996). "Overproduction of proinflammatory cytokines imbalanced by their antagonists in POEMS syndrome". Blood. 87 (4): 1458–65. PMID 8608236.
  2. ↑ 2.0 2.1 Nozza A (2017). "POEMS SYNDROME: an Update". Mediterr J Hematol Infect Dis. 9 (1): e2017051. doi:10.4084/MJHID.2017.051. PMC 5584767. PMID 28894560.
  3. ↑ 3.0 3.1 3.2 Bardwick PA, Zvaifler NJ, Gill GN, Newman D, Greenway GD, Resnick DL (July 1980). "Plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes: the POEMS syndrome. Report on two cases and a review of the literature". Medicine (Baltimore). 59 (4): 311–22. PMID 6248720.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 Takatsuki K, Sanada I (September 1983). "Plasma cell dyscrasia with polyneuropathy and endocrine disorder: clinical and laboratory features of 109 reported cases". Jpn. J. Clin. Oncol. 13 (3): 543–55. PMID 6315993.
  5. ↑ Nobile-Orazio E, Terenghi F, Giannotta C, Gallia F, Nozza A (March 2009). "Serum VEGF levels in POEMS syndrome and in immune-mediated neuropathies". Neurology. 72 (11): 1024–6. doi:10.1212/01.wnl.0000344569.13496.ff. PMID 19289745.
  6. ↑ Güneş HN, Bilecenoğlu NT, Şener U, Yoldaş TK (April 2015). "POEMS syndrome with peripheral and central nervous system demyelination: case report". Neurologist. 19 (4): 101–3. doi:10.1097/NRL.0000000000000017. PMID 25888197.
  7. ↑ "IMWG | International Myeloma Working Group (IMWG) Criteria for the Diagnosis of Multiple Myeloma".
  8. ↑ Schreiber AK, Nones CF, Reis RC, Chichorro JG, Cunha JM (April 2015). "Diabetic neuropathic pain: Physiopathology and treatment". World J Diabetes. 6 (3): 432–44. doi:10.4239/wjd.v6.i3.432. PMID 25897354.
  9. ↑ "Diagnosis and classification of diabetes mellitus". Diabetes Care. 33 Suppl 1: S62–9. January 2010. doi:10.2337/dc10-S062. PMID 20042775.
  10. ↑ Ekabe CJ, Kehbila J, Abanda MH, Kadia BM, Sama CB, Monekosso GL (January 2017). "Vitamin B12 deficiency neuropathy; a rare diagnosis in young adults: a case report". BMC Res Notes. 10 (1): 72. doi:10.1186/s13104-017-2393-3. PMID 28129784.
  11. ↑ Doi T, Kawata T, Tadano N, Iijima T, Maekawa A (February 1989). "Effect of vitamin B12 deficiency on S-adenosylmethionine metabolism in rats". J. Nutr. Sci. Vitaminol. 35 (1): 1–9. PMID 2738712.
  12. ↑ Berg RL, Shaw GR (February 2013). "Laboratory evaluation for vitamin B12 deficiency: the case for cascade testing". Clin Med Res. 11 (1): 7–15. doi:10.3121/cmr.2012.1112. PMID 23262189.
  13. ↑ Lindenbaum J, Savage DG, Stabler SP, Allen RH (June 1990). "Diagnosis of cobalamin deficiency: II. Relative sensitivities of serum cobalamin, methylmalonic acid, and total homocysteine concentrations". Am. J. Hematol. 34 (2): 99–107. PMID 2339684.
  14. ↑ Berg RL, Shaw GR (February 2013). "Laboratory evaluation for vitamin B12 deficiency: the case for cascade testing". Clin Med Res. 11 (1): 7–15. doi:10.3121/cmr.2012.1112. PMC 3573090. PMID 23262189.
  15. ↑ Lane LA, Rojas-Fernandez C (2002). "Treatment of vitamin b(12)-deficiency anemia: oral versus parenteral therapy". Ann Pharmacother. 36 (7–8): 1268–72. doi:10.1345/aph.1A122. PMID 12086562.
  16. ↑ Winer JB (December 2001). "Guillain Barré syndrome". MP, Mol. Pathol. 54 (6): 381–5. PMC 1187127. PMID 11724912.
  17. ↑ Rees JH, Gregson NA, Hughes RA (November 1995). "Anti-ganglioside GM1 antibodies in Guillain-Barré syndrome and their relationship to Campylobacter jejuni infection". Ann. Neurol. 38 (5): 809–16. doi:10.1002/ana.410380516. PMID 7486873.
  18. ↑ Winer JB, Hughes RA, Anderson MJ, Jones DM, Kangro H, Watkins RP (May 1988). "A prospective study of acute idiopathic neuropathy. II. Antecedent events". J. Neurol. Neurosurg. Psychiatry. 51 (5): 613–8. PMC 1033063. PMID 3404161.
  19. ↑ Yuki N, Koga M (October 2006). "Bacterial infections in Guillain-Barré and Fisher syndromes". Curr. Opin. Neurol. 19 (5): 451–7. doi:10.1097/01.wco.0000245367.36576.e9. PMID 16969154.
  20. ↑ Kimura J (April 1978). "Proximal versus distal slowing of motor nerve conduction velocity in the Guillain-Barré syndrome". Ann. Neurol. 3 (4): 344–50. doi:10.1002/ana.410030412. PMID 666277.
  21. ↑ Winer JB (December 2001). "Guillain Barré syndrome". MP, Mol. Pathol. 54 (6): 381–5. PMC 1187127. PMID 11724912.
  22. ↑ "Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barré syndrome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group". Lancet. 349 (9047): 225–30. January 1997. PMID 9014908.
  23. ↑ "Plasmapheresis and acute Guillain-Barré syndrome. The Guillain-Barré syndrome Study Group". Neurology. 35 (8): 1096–104. August 1985. PMID 4022342.
  24. ↑ "Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Clinical Characteristics, Course, and Recommendations for Diagnostic Criteria | JAMA Neurology | JAMA Network".
  25. ↑ "onlinelibrary.wiley.com".
  26. ↑ Milner P, Lovelidge CA, Taylor WA, Hughes RA (July 1987). "P0 myelin protein produces experimental allergic neuritis in Lewis rats". J. Neurol. Sci. 79 (3): 275–85. PMID 2440998.
  27. ↑ Gabriel CM, Gregson NA, Hughes RA (May 2000). "Anti-PMP22 antibodies in patients with inflammatory neuropathy". J. Neuroimmunol. 104 (2): 139–46. PMID 10713353.
  28. ↑ Bouchard C, Lacroix C, Planté V, Adams D, Chedru F, Guglielmi JM, Said G (February 1999). "Clinicopathologic findings and prognosis of chronic inflammatory demyelinating polyneuropathy". Neurology. 52 (3): 498–503. PMID 10025777.
  29. ↑ Yan WX, Archelos JJ, Hartung HP, Pollard JD (September 2001). "P0 protein is a target antigen in chronic inflammatory demyelinating polyradiculoneuropathy". Ann. Neurol. 50 (3): 286–92. PMID 11558784.
  30. ↑ Barohn RJ, Kissel JT, Warmolts JR, Mendell JR (August 1989). "Chronic inflammatory demyelinating polyradiculoneuropathy. Clinical characteristics, course, and recommendations for diagnostic criteria". Arch. Neurol. 46 (8): 878–84. PMID 2757528.
  31. ↑ Barohn RJ, Kissel JT, Warmolts JR, Mendell JR (August 1989). "Chronic inflammatory demyelinating polyradiculoneuropathy. Clinical characteristics, course, and recommendations for diagnostic criteria". Arch. Neurol. 46 (8): 878–84. PMID 2757528.
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