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Case Reports
. 2017 Sep 23;9(10):129.
doi: 10.3390/cancers9100129.

Alcohol Misuse Link to POEMS Syndrome in a Patient

John Neary  1 , Susan E Goodwin  2 , Lawrence B Cohen  3 , Manuela G Neuman  4
Affiliations
Case Reports

Alcohol Misuse Link to POEMS Syndrome in a Patient

John Neary et al. Cancers (Basel). .

Abstract

Previously called Crow-Fukase syndrome, POEMS syndrome is characterized by poly-neuropathy, osteo-sclerotic myeloma, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes. Extremely elevated levels of serum vascular endothelial growth factor (VEGF) are characteristic of the syndrome. Chronic hepatitis B (HBV) and C (HCV) infections can also be present in POEMS. The pathogenesis of the syndrome is not well understood. The link between chronic alcohol consumption and this malignant condition has not been reported until now. In addition, no previous study has evaluated the influence of cytokine and chemokines or viruses in the severity and evolution of POEMS.

Objectives: (1) to describe a heavy-alcohol user, who was diagnosed with POEMS; (2) to demonstrate the utility of quantitative measurement of serum levels of VEGF in the diagnosis of POEMS and the monitoring of therapeutic interventions; (3) to demonstrate that overproduction of pro-inflammatory cytokines is a characteristic of POEMS.

Methods: We describe a case of a POEMS patient presenting HCV and who is a heavy drinker; we compare the serum levels of cytokines and chemokines between the POEMS patient with 80 patients with HCV, 12 healthy controls, and 80 individuals with alcoholic liver disease (ALD). We quantified (ELISA pg/mL) the levels of VEGF, Interferon gamma (IFN-γ), Tumor Necrosis Factor alpha (TNF-α), Regulated-upon-Activation Normal-T-cell-Expressed and presumably-Secreted (RANTES), and Nuclear Factor kappa-B (NFκB).

Results: In POEMS patients, VEGF levels were elevated versus control or other diseases, TNFα levels were higher versus control, but lower when compared with HCV or ALD patients. VEGF levels in POEMS patients decreased with therapeutic intervention.

Conclusions: Chronic alcohol misuse can be a strong risk factor to rare malignancies such as POEMS syndrome. Extreme elevation of VEGF levels is diagnostic for POEMS syndrome, and should be followed to assess response to therapy. In addition, other comorbidities should be considered individually to ensure personalized therapeutic intervention.

Keywords: POEMS; RANTES; TNF-alpha; VEGF; alcohol; biomarkers; malignancy.

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Conflict of interest statement

The authors declare no conflict of interest. J. Neary and S.E. Goodwin are the treating physicians of the patient, L.B. Cohen clinically diagnosed and treated the patients from the control groups and M.G. Neuman designed the study and performed all the laboratory analyses of the entire study. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Levels of Interleukin 6, INFγ, RANTES and NFκB. The values are presented as pg/mL. The results of the 12 control individuals and patients with HCV (80) and ALD (80) represent the median value of the group. HCV patients were male and female Caucasians with a median age of 39, non-cirrhotic with a fibrosis score F0–F1. ALD patients were only Caucasian male with a median age of 52, non-cirrhotic with a fibrosis score F0–F1. All these patients have been evaluated in a Hepatology clinic.
Figure 2
Figure 2
Levels of TNF-α and VEGF (pg/mL). The POEMS + ALD + HCV patients were compared with 12 healthy controls, 80 patients with HCV, and 80 with ALD. Results are given in pg/mL. The results of the 12 control individuals and patients with HCV (80) and ALD (80) represent the median value of the group.
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References

    1. Gosselin S., Kyle R.A., Dyck P.J. Neuropathy associated with monoclonal gammopathies of undetermined significance. Ann. Neurol. 1991;30:54. doi: 10.1002/ana.410300111. - DOI - PubMed
    1. Joint Task Force of the EFNS and the PNS European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of paraproteinemic demyelinating neuropathies. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society-first revision. J. Peripher. Nerv. Syst. 2010;15:185. - PubMed
    1. Ritz M.F., Erne B., Ferracin F., Vital A., Vital C., Steck A.J. Anti-MAG IgM-penetration into myelinated fibers correlates with the extent of myelin widening. Muscle Nerve. 1999;22:1030–1037. doi: 10.1002/(SICI)1097-4598(199908)22:8<1030::AID-MUS4>3.0.CO;2-H. - DOI - PubMed
    1. Kawagashira Y., Koike H., Tomita M., Morozumi S., Iijima M., Nakamura T., Katsuno M., Tanaka F., Sobue G. Morphological progression of myelin abnormalities in IgM-monoclonal gammopathy of undetermined significance anti-myelin-associated glycoprotein neuropathy. J. Neuropathol. Exp. Neurol. 2010;69:1143–1157. doi: 10.1097/NEN.0b013e3181fa44af. - DOI - PubMed
    1. Dispenzieri A. POEMS syndrome: 2017 update on diagnosis, risk stratifications, and management. Am. J. Haematol. 2017;92:814–829. doi: 10.1002/ajh.24802. - DOI - PubMed

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