“The Dizziness is Unnerving”: Monoclonal gammopathy of unknown significance presenting as severe neuropathy: A case report

Neuropathic pain is common and is one of the most disabling symptoms of many disease states[1].This case study highlights a 59-year-old female patient who presented with severe peripheral neuropathy and fainting episodes. Initial treatment provided little relief, so the patient returned to the office, as the dizziness she was reporting had gotten significantly worse. After a significant work up over multiple months, the medical care team diagnosed the patient with monoclonal gammopathy of unknown significance (MGUS). This was done through a CT guided bone marrow aspirate and biopsy that showed a high plasma cell count. The only reason this test was ordered was because a wide differential diagnosis was maintained throughout the patient’s encounter with the medical team, allowing for flexibility in testing and treatment when the initial approach failed to work. This paper aims to highlight the purpose of a wide differential when treating patients with neuropathic pain syndromes, especially with severe symptoms including autonomic dysfunction. The possibilities of a differential are highlighted in the paper through a review of the literature on the presentations of neuropathic pain syndromes. This case highlights how a wide differential may have prevented a patient with peripheral neuropathy from developing further sequela of her disease state.