Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.135
Peer-review started: August 27, 2022
First decision: October 21, 2022
Revised: November 4, 2022
Accepted: December 9, 2022
Article in press: December 9, 2022
Published online: January 6, 2023
Processing time: 120 Days and 11.2 Hours
Polyneuropathy organomegaly endocrinopathy M-protein and skin changes (POEMS) syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor. The clinical manifestations of POEMS syndrome are diverse. Due to the insidious onset and lack of specific early-stage manifestations, POEMS syndrome is easily misdiagnosed or never diagnosed, leading to delayed treatment. Neurological symptoms are usually the first clinical manifestation, while ascites is a rare symptom in patients with POEMS syndrome.
A female patient presented with unexplained ascites as an initial symptom, which is a rare early-stage manifestation of the condition. After 1 year, the patient gradually developed progressive renal impairment, anemia, polyserosal effusion, edema, swollen lymph nodes on the neck, armpits, and groin, and decreased muscle strength of the lower extremities. The patient was eventually diagnosed with POEMS syndrome after multidisciplinary team discussion. Treatment comprised bortezomib + dexamethasone, continuous renal replacement therapy, chest and abdominal closed drainage, transfusions of erythrocytes and platelets, and other symptomatic and supportive treatments. The patient’s condition initially improved after treatment. However, then her symptoms worsened, and she succumbed to the illness and died.
Ascites is a potential early manifestation of POEMS syndrome, and this diagnosis should be considered for patients with unexplained ascites. Furthermore, multidisciplinary team discussion is helpful in diagnosing POEMS syndrome.
Core Tip: Polyneuropathy organomegaly endocrinopathy M-protein and skin changes (POEMS) syndrome is a rare paraneoplastic syndrome caused by a potential plasma cell tumor. The clinical manifestations of POEMS syndrome are diverse, and the syndrome is often misdiagnosed or never diagnosed, resulting in delayed treatment and a poor outcome. Ascites might be an early clinical manifestation of POEMS syndrome. Thus, POEMS syndrome should be considered as a potential diagnosis for patients with unexplained ascites. Furthermore, multidisciplinary team discussion is helpful in the diagnosis of POEMS syndrome.