SHM Converge Scientific Abstract ePoster Gallery-Poems Syndrome With Concomitant Multiple Myeloma: A Rare Intersection

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This case describes a 60-year-old woman with a history of Castleman disease who developed progressive stocking-and-glove polyneuropathy and was evaluated for POEMS syndrome after an abnormal EMG. She had exam findings including fingernail whitening, left supraclavicular lymphadenopathy, mild facial droop, distal numbness, and weakness in grip and plantarflexion.<br /><br />Laboratory studies showed anemia, thrombocytosis, elevated ESR and CRP, hypothyroidism, elevated VEGF and IL-6, and an IgG lambda monoclonal protein. Imaging revealed worsening lytic bone lesions, new rib and spine lesions, a T5–T7 lobulated mass, and marrow-replacing lesions from C7 to L1. Lymph node pathology demonstrated a lambda-restricted plasma cell neoplasm, and biopsy of the spinal mass confirmed plasmacytoma. Bone marrow biopsy showed mildly hypercellular marrow with polytypic plasmacytosis and a subset of plasma cells with aberrant TP53 signaling.<br /><br />The patient was diagnosed with POEMS syndrome concomitant with classical multiple myeloma. This distinction was important because POEMS and multiple myeloma can overlap clinically but require different diagnostic framing and treatment approaches. In this case, the patient met POEMS criteria through polyneuropathy, monoclonal plasma cell disorder, Castleman disease, elevated VEGF, and minor features including hypothyroidism, skin changes, and thrombocytosis. Features supporting multiple myeloma included plasmacytoma, lytic bone lesions, and anemia.<br /><br />She was treated with daratumumab, lenalidomide, and dexamethasone, along with radiation therapy to spinal lesions, and discharged to inpatient rehabilitation. At 3-month follow-up, she reported improvement in neuropathy, balance, and activities of daily living.<br /><br />The report highlights how rare this dual diagnosis is and emphasizes the importance of distinguishing POEMS syndrome from multiple myeloma to avoid delayed or inappropriate treatment.

Asset Subtitle

Michael Poliner

Meta Tag

Author List Anupama Suresh, Megan Yeh, Michael Poliner, Naresh Bumma, Rohan Makhijani

Category Clinical Vignettes

Concept POEMS Syndrome

Concept Multiple Myeloma

Concept Diagnostic Criteria

Concept Mandatory Criteria

Concept Major criteria

Distinguished Non-Finalist

Presenter Organization The Ohio State University

Presenting Author Michael Poliner

Track Adult

Keywords

POEMS syndrome

multiple myeloma

Castleman disease

polyneuropathy

plasma cell neoplasm

elevated VEGF

IgG lambda monoclonal protein

plasmacytoma

lytic bone lesions

daratumumab lenalidomide dexamethasone

POEMS Syndrome

Multiple Myeloma

Diagnostic Criteria

Mandatory Criteria

Major criteria