title: Complete heart block in a patient with POEMS syndrome: A case report.
abstract: BACKGROUND
  Polyneuropathy, organomegaly, endocrinopathy, monoclonal syndrome (POEMS) is a rare paraneoplastic syndrome associated with plasma cell dyscrasia.
  
  
  METHODS
  A 48-year-old man presented with a 1-year history of paresthesia and progressive weakness of extremities. Diagnosis of POEMS syndrome was made for him on the basis of clinical presentation, additional physical findings, typical sclerotic bone lesion, and bone marrow findings. In last admission, he explained episodes of dyspnea and chest pain that associated with frequent premature ventricular contraction in his electrocardiograph. Patient heart monitoring showed some episodes of complete heart block. Infra-His atrioventricular block in electro-physiologic study was detected. He had no history of ischemic heart disease. His cardiopulmonary findings on examination were normal. All results of cardiac biomarkers and serum electrolytes and repeated echocardiography were within normal range. Cong red staining of rectal fat pad biopsy was negative. After pacemaker insertion radiation of sclerotic bone, lesion started for him, but radiotherapy was ineffective, and he expired with respiratory failure. Complete heart block in POEMS syndrome has not been reported previously, and it is the first POEMS case with complete heart block.
  
  
  CONCLUSIONS
  Complete heart block is a cardiac manifestation of POEMS syndrome.
authors.affiliation: Assistant Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Ashrafi
authors.affiliation: Resident, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Darakhshandeh
authors.affiliation: Pathologist, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Pardis
authors.initials: P
authors.lastname: Nematolahy
authors.affiliation: Associate Professor, Interventional Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Khosravi
keywords: Complete Heart Block; Multiple Meloma; POEM Syndrome