title: POEMS syndrome: complex factors contributing to a delayed diagnosis.
abstract: POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes) syndrome is a rare paraneoplastic syndrome due to an underlying plasma cell disorder. The chronically evolving nature of this syndrome and diverse clinical manifestations make it a challenging diagnosis, especially in the early stages of the disease. We present a case that illustrates well how these confounding factors can delay recognition of the disorder. We describe the presentation of some of the classical symptoms, and discuss how investigations can be optimised in order to fit together the clinical picture. Recent advances in the understanding of nerve conduction studies and electromyography in POEMS may help improve the early identification of this disease. This is of great importance, as early recognition and the initiation of appropriate treatment can reduce morbidity and mortality in POEMS.
authors.affiliation: School of Medicine, Kings College London, London, UK.
authors.forename: Rebecca Caroline
authors.initials: RC
authors.lastname: Robey
authors.affiliation: School of Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Campus
authors.affiliation: Atlanta Veteran Administration Medical Center, Atlanta, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Ringuette
authors.affiliation: School of Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Shumate
mesh_terms: D057210:Delayed Diagnosis; D003907:Dexamethasone / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004576:Electromyography; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D016878:POEMS Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D013792:Thalidomide / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; D007155:Immunologic Factors; D013792:Thalidomide; D003907:Dexamethasone; D000077269:Lenalidomide