A case of POEMS syndrome with high concentrations of interleukin‐6 in pericardial fluid

Shikama, Nobuaki; Isono, Akari; Otsuka, Yuichiro; Terano, Takashi; Hirai, Aizan

doi:10.1046/j.1365-2796.2001.00863.x

Cited by 11 publications

(7 citation statements)

References 21 publications

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“…However, in some reports, IL-6 in the ascites (IL-6: 15 pg/mL) in the serum vs. 1,650 pg/mL in the ascites (Nakazawa et al 1992) or pericardial fluid but not in the serum (IL-6: 6.57 pg/mL) in the serum vs. 1,760 pg/mL in the pericardial fluid and 1,630 pg/ml in the ascitis (Shikama et al 2001) was elevated. However, in some reports, IL-6 in the ascites or pericardial fluid was elevated (Nakazawa et al 1992;Ako et al 1999;Shikama et al 2001). Therefore, it is important to detect not only the cytokines in the serum but also in the pericardial, pleural, and peritoneal fluid.…”

Section: Discussionmentioning

confidence: 92%

“…In general, VEGF, IL-6, and IL-12 are cytokines, which show higher level in the serum of POEMS patients and IL-6 but not IL-1β and TNFα reflected the disease activity (Hitoshi et al 1994;Kanai et al 2012). However, in some reports, IL-6 in the ascites (IL-6: 15 pg/mL) in the serum vs. 1,650 pg/mL in the ascites (Nakazawa et al 1992) or pericardial fluid but not in the serum (IL-6: 6.57 pg/mL) in the serum vs. 1,760 pg/mL in the pericardial fluid and 1,630 pg/ml in the ascitis (Shikama et al 2001) was elevated. However, in some reports, IL-6 in the ascites or pericardial fluid was elevated (Nakazawa et al 1992;Ako et al 1999;Shikama et al 2001).…”

Section: Discussionmentioning

confidence: 97%

“…The patient exhibited 0.3 g/day proteinuria, but no microhaematuria was seen. Commercially available kits for enzyme-linked immunosorbent assay (ELISA) were used to detect interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) (R&D System, Mineapolis, MN, USA) (Shikama et al 2001). Increased levels of serum cytokines were also detected including IL-1β as 0.699 pg/mL (normal < 0.567 pg/mL), IL-6 as 8.9 pg/mL (normal < 4.62 pg/mL) and VEGF as 83.2 pg/mL (normal < 38.3 pg/mL), respectively.…”

Section: Clinical Coursementioning

confidence: 99%

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A Patient with POEMS Syndrome: The Pathology of Glomerular Microangiopathy

Nakamura

Nishimura

Terano

et al. 2013

Tohoku J. Exp. Med.

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POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes) is potentially fatal multisystem disorder but its renal complication has often been overlooked because renal involvement is not necessarily included in the diagnostic criteria of POEMS. This report documents the patient with POEMS syndrome with long-term renal histopathological changes evaluated by renal biopsy. A 32-year-old Japanese woman presented with symptoms consistent with POEMS syndrome associated with proteinuria and IgA-λ type monoclonal gammopathy. Initial renal biopsy for confirmation of diagnosis revealed the proliferation of glomerular capillary loops located in the expanded mesangial matrices associated with glomerular enlargement. Electron microscopy examination of the renal biopsy revealed the presence of double contoured glomerular basement membrane containing peculiar fibrillary structure. The patient was therefore initially diagnosed as membranoproliferative glomerulonephritis (MPGN)-like lesion without any significant immunoglobulins and complements deposition. The patient was subsequently admitted to hospital on five occasions due to renal dysfunction and anasarca for the next four years of her clinical course. The severity of anasarca was correlated mainly with serum titer of vascular endothelial growth factor (VEGF) during this period. Acute renal failure occurred at the last admission and the second biopsy was performed. An increased mesangial matrix and frequent global sclerosis of the glomeruli with arteriolosclerosis was noted in this second biopsy compared to the first one. These findings of renal biopsies suggest that the glomerular microangiopathy of POEMS syndrome may occur in the context of systemic capillary leak syndrome superimposed on chronic endothelial injury.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Section: Clinical Coursementioning

confidence: 99%

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A Patient with POEMS Syndrome: The Pathology of Glomerular Microangiopathy

Nakamura

Nishimura

Terano

et al. 2013

Tohoku J. Exp. Med.

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“…In a case presented by Shikama N et al [15] a patient with cardiac tamponade had high levels of IL6 in the pericardial fluid compared with serum levels (1760 vs. 6.57pg/mL). There are no published randomized clinical trials for the treatment of Castleman disease.…”

Section: Discussionmentioning

confidence: 92%

An Unusual Presentation of Plasma Cells – Castleman Disease: A Case Report

Mihaila

Herlea

Dobrea

et al. 2016

Romanian Journal of Internal Medicine

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We present the case of a 76 year old female patient admitted in the Department of Cardiology for physical asthenia, profuse sweating and dyspnea with orthopnea for about one month. Clinical and paraclinical assessments performed at admission confirmed the diagnosis of cardiac tamponade. Surgical intervention was performed and 400 mL of clear effusion were drained. Post-operative evolution was marked by recurrence of symptoms, requiring after 3 weeks a new drainage of 600 mL of clear effusion, and biopsy of the pericardium was performed. Pathological exam described serous pericarditis with chronic inflammatory infiltrate, xanthogranulomatous reaction intricated in the pericardium and mesothelial hyperplasia. The patient was subsequently transferred to the Department of Internal Medicine for further investigations. Physical examination showed a patient with altered general status, pallor, vesicular murmur absent in both bases, presenting cutaneous hyperpigmentation at the level of the right hemi-abdomen and hip with posterior extension, and a peripheral indurated erythematous plaque. The patient presented nodular masses of 3 cm in the right latero-cervical and bilateral axillary regions, non-adherent to the superficial structures, as well as adenopathic blocks in both inguinal regions. CT scan of the thorax and abdomen showed moderate bilateral pleuresia, minimal pericardial effusion (15 mm) and multiple adenopathies on both sides of the diaphragm. Skin biopsy was performed, as well as bone marrow aspirate and excision of a right axillary lymph node. Pathological exams and immunohistochemistry tests confirmed the diagnosis of Plasma Cells Castleman disease.

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“…4 Because acute edema is necessary to cause AECDS in a short period, RS3PE syndrome may also cause AECDS during its aggressive condition. Because a major trigger condition with anorexia nervosa exhibits normal level of VEGF, 5 it should be kept in mind that VEGF-related diseases are a completely different novel entity to cause AECDS.…”

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confidence: 99%