Ivory Vertebra: A Rare Skeletal Manifestation of POEMS Syndrome

POEMS syndrome is a paraneoplastic condition characterized by peripheral neuropathy and monoclonal plasma cell dysfunction. additional major criteria include sclerotic bone lesions. Malignancies such Hodgkin lymphoma, metastatic prostate cancer, breast cancer, and Paget's disease frequently feature ivory vertebra.

A 21-year-old female exhibited symmetric onset of lower motor neuron weakness in both lower limbs, beginning distally and subsequently progressing to proximal involvement, accompanied by sensory loss during the past 8 months. The examination indicated skin hyperpigmentation, pallor, hepatomegaly, and papilledema. Nerve conduction shows axonal sensory-motor neuropathy, whereas bone marrow analysis reveals reactive marrow with 5% plasma cells and variable cellularity. Serum electrophoresis reveals an elevation of M protein in the gamma region. X-ray and MRI spine revealing sclerotic vertebra lesion of body of D11 vertebra, characteristics of ivory vertebra.

Ivory vertebra may be a feature of POEMS syndrome in appropriate clinical context. Ivory vertebra is usually associated with various malignancy conditions.