POEMS Syndrome: A Case Highlighting the Challenges in Diagnosis

Abstract

POEMS syndrome is a multisystem disorder characterized by polyneuropathy, organomegaly, endocrinopathy, and skin changes in the context of a monoclonal plasma cell disorder. While these features may appear in the syndrome, they do not always occur simultaneously and can present with multiple other symptoms. A thorough laboratory and radiological workup is recommended to assess for multisystem involvement, and a bone marrow or skeletal lesion biopsy may be necessary to confirm an underlying plasma cell disorder. Given the wide range of possible presentations, diagnosing POEMS can be challenging and may be confused with CIDP or smoldering myeloma. However, maintaining a high clinical suspicion this syndrome, even when not all features are present, is crucial for a timely diagnosis and optimal treatment, particularly for neurological recovery. We present the case of a 57-year-old male with progressive sensorimotor weakness who was initially diagnosed with CIDP but ultimately found to have POEMS syndrome, based on elevated VEGF levels, IgG lambda monoclonal gammopathy, sclerotic bone lesions, skin changes, endocrinopathy, and a biopsy-proven plasmacytoma.