SHM Converge Scientific Abstract ePoster Gallery-Delayed Diagnosis in a Case of Polyneuropathy: An All-Too-Common Refrain

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This case describes a man whose POEMS syndrome was recognized only after years of progressive symptoms. He initially developed tingling, numbness, and burning pain in his feet and calves, which was treated as diabetic neuropathy without benefit. Years later, spinal imaging done for back pain incidentally revealed multiple sclerotic bone lesions. Workup showed a small M-protein and a bone biopsy with monoclonal plasma cells, but no multiple myeloma, so he was observed.<br /><br />Over the next several years, his neuropathy worsened and spread to his upper extremities, causing difficulty walking. He also developed leg swelling. Additional testing showed severe sensorimotor peripheral neuropathy, IgG lambda monoclonal gammopathy, elevated beta-2 microglobulin, thrombocytosis, and hypothyroidism. On hospital admission for acute kidney injury from urinary retention, further evaluation found papilledema. Although his VEGF level was normal, he met diagnostic criteria for POEMS syndrome based on polyneuropathy, monoclonal plasma cell disorder, sclerotic bone lesions, and several minor features including endocrinopathy, edema, thrombocytosis, and papilledema.<br /><br />The report emphasizes that POEMS syndrome is rare, heterogeneous, and often misdiagnosed, commonly as diabetic neuropathy or chronic inflammatory demyelinating polyneuropathy. Diagnosis is frequently delayed, sometimes for years after symptom onset. Early recognition matters because treatment can slow disease progression. The key takeaway is that clinicians should consider POEMS early in patients with unexplained polyneuropathy, especially when monoclonal gammopathy or sclerotic bone lesions are present, even if not all criteria are immediately obvious.

Asset Subtitle

Alexander Harris

Meta Tag

Author List Alexander Harris

Category Clinical Vignettes

Concept POEMS Syndrome

Concept Polyneuropathy

Concept Diagnostic Criteria

Concept Monoclonal Gammopathy

Concept Osteosclerotic Bone Lesion

Distinguished Non-Finalist

Presenter Organization University of Michigan

Presenting Author Alexander Harris

Track Adult

Keywords

POEMS syndrome

polyneuropathy

monoclonal gammopathy

sclerotic bone lesions

IgG lambda

peripheral neuropathy

papilledema

thrombocytosis

endocrinopathy

misdiagnosis

POEMS Syndrome

Polyneuropathy

Diagnostic Criteria

Monoclonal Gammopathy

Osteosclerotic Bone Lesion