Peripheral neuropathy was present in all of our 99 patients and usually dominates the clinical picture.52 Symptoms usually begin in the feet and consist of tingling or paresthesias. Motor involvement follows the sensory symptoms. Both begin distally and are symmetric and progress proximally. More than half of the patients have severe weakness and may have difficulty in climbing stairs, rising from a chair, or gripping objects firmly. In contrast to the neuropathy associated with primary amyloidosis (AL), autonomic symptoms are not a feature. Bone pain and pathologic fractures are major findings in symptomatic myeloma, but occur rarely in POEMS syndrome.
Physical examination reveals a symmetric, sensori-motor neuropathy involving the extremities. Muscle weakness is usually more marked than sensory loss. Touch, pressure, vibratory, and joint position senses are often involved, whereas loss of temperature discrimination and nociception occur less frequently. Papilledema was present in almost one-third of our patients. However, other cranial nerves are not affected.
Hepatomegaly, splenomegaly, and lymphadenopa-thy were present in about one-fourth of patients. Hyperpigmentation was present in almost one-half of patients, but it was easily overlooked. Hypertrichosis, manifested by coarse black hair, appeared on the extremities in one-fourth of our patients, and telang-iectasia and hemangiomas were present in 10%. Peripheral edema was found in one-fourth of our patients, but ascites and pleural effusion were uncommon. Clubbing of the fingers has been noted but was infrequent in our series.
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