[Polyneuropathy associated with plasma cell dyscrasia and endocrinological abnormalities--a trial of plasmapheresis]

Plasmapheresis and irradiation of the tumor were performed in conjunction with prednisolone therapy to a severe case of polyneuropathy associated with a solitary sclerotic secreting myeloma and endocrinological abnormalities. The patient was 27-year-old male with progressive history of polyneuropathy of seven months duration. On admission, he was quadriplegic with cranial nerve involvements. Pitting type of generalized edema, skin pigmentation and sensory impairment were also present. Respiratory failure occurred soon after the admission. Plasmapheresis lowered the level of M protein but failed to improve clinical course in the short term. On the other hand, prompt amelioration of clinical symptoms followed the irradiation of the tumor. It is difficult to prove clinical effects of plasmapheresis upon symptoms of chronic polyneuropathy. It is suggested that some humoral factor of myeloma might attribute to this syndrome and secreted at higher rate than our plasmapheresis but easily suppressed by the irradiation of the tumor. We suppose that radiation therapy could be the treatment of the first choice for such a severe case like ours. However, further experiences of plasmapheresis of this syndrome are necessary to determine the effect of plasmapheresis. Some other etiological aspects are also discussed.