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A 75 year old diabetic is diagnosed with multiple myeloma. He has renal failure with serum creatinine of 3.1 mgdl. He is started on chemotherapy consisting of dexamethasone, lenalidomide and bortezomib. After the third cycle, the patient develops a severe painful neuropathy. Which of these would be the most likely diagnosis?
Explanation
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Diabetes mellitus predisposes to toxic neuropathy by chemotherapeutic drugs. It is unlikely to present suddenly in the presence of stable blood sugars. Uremic neuropathy is seen in end stage renal failure of long duration. Bortezomib frequently causes dose dependent sensory neuropathy. Neuropathy may reverse on stopping the drug or reducing the dose, however it will reappear on subsequent retreatment. Thalidomide caused dorsal root ganglion degeneration with painful neuropathy, palmar erythema and brittle nails. Neuropathy is seen with cumulative dose more than 100 gm. Lenalidomide causes neuropathy less frequently
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Reference
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Katirji B. Disorders of Peripheral Nerves. Bradley and Daroffs Neurology in Clinical Practice. 2022. Ch 1061853
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Option 1
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Is Correct (Option 1):
Diabetic neuropathy
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Option 2
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Is Correct (Option 2):
Uremic neuropathy
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Option 3
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Is Correct (Option 3):
Bortezomib toxicity
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Option 4
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Is Correct (Option 4):
Lenalidomide neuropathy
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