[A patient with lambda type light-chain disease associated with Crow-Fukase syndrome and autoimmune thrombocytopenia]

Rinsho Shinkeigaku. 1991 Nov;31(11):1248-51.
[Article in Japanese]

Abstract

A 67-year-old woman, who presented polyneuropathy, pleural effusion, ascites and sclerosing changes in the ribs, was admitted to our hospital on June 17, 1987. On admission, cerebrospinal examination showed a marked protein-cell dissociation and a delay in nerve conduction velocity. Bence-Jones protein was detected in urine, and the immunohistochemical study of biopsied bone marrow of the rib revealed lambda-chain positive plasmacytoma. Serum immunoelectrophoresis, however, showed no monoclonal gamma-globulinemia. From the findings described above, she was diagnosed as having Crow-Fukase syndrome associated with lambda-type light chain disease. Even with a therapy by prednisolone, platelet counts progressively declined to 10,000/ml3. Bone marrow aspiration showed normal number of megakaryocytes. Since platelet-associated IgG was increased to 452 ng/1.0 x 10(8) plt, a diagnosis of autoimmune thrombocytopenia was considered. Melphalan and cyclophosphamide to plasmacytoma resulted in a marked improvement of platelets. In addition, the level of platelet-associated IgG returned to normal range. Polyneuropathy, however, didn't respond to those therapies. It was suggested that both Crow-Fukase syndrome and thrombocytopenia were closely concerned with plasmacytoma but developed in a different manner.

Publication types

  • Case Reports
  • English Abstract

MeSH terms

  • Aged
  • Cyclophosphamide / therapeutic use
  • Female
  • Humans
  • Hypergammaglobulinemia / complications*
  • Immunoglobulin G / metabolism
  • Immunoglobulin Light Chains*
  • Immunoglobulin lambda-Chains*
  • Melphalan / therapeutic use
  • POEMS Syndrome / complications*
  • Paraproteinemias / complications
  • Thrombocytopenia / drug therapy
  • Thrombocytopenia / etiology*

Substances

  • Immunoglobulin G
  • Immunoglobulin Light Chains
  • Immunoglobulin lambda-Chains
  • Cyclophosphamide
  • Melphalan