This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 6, 2023; 11(1): 135-142 Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.135
Polyneuropathy organomegaly endocrinopathy M-protein and skin changes syndrome with ascites as an early-stage manifestation: A case report
Xiao-Lei Zhou, Ying-Hao Chang, Lan Li, Juan Ren, Xiao-Ling Wu, Xue Zhang, Peng Wu, Shan-Hong Tang
Xiao-Lei Zhou, Shan-Hong Tang, Graduate School, Southwest Medical University, Luzhou 646099, Sichuan Province, China
Xiao-Lei Zhou, Lan Li, Juan Ren, Xiao-Ling Wu, Xue Zhang, Peng Wu, Shan-Hong Tang, Department of Gastroenterology, General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Ying-Hao Chang, Department of Infectious Diseases, General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Author contributions: Zhou XL and Chang YH were the patient’s physicians, reviewed the literature, and contributed to manuscript drafting; Li L, Ren J, and Wu XL contributed to manuscript drafting and interpreted the imaging findings; Zhang X and Wu P contributed to revision of the manuscript; Tang SH was responsible for revising the manuscript for important intellectual content; All authors approved the final submitted version of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient and her relatives for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist, and the manuscript was prepared and revised according to the CARE Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: August 27, 2022 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
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
