POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder and skin changes) associated with Castleman disease and latent tuberculosis: a diagnostic challenge.
Praveen Kumar Kaudlay Sathyanarayana, Kandathil Mathew, Ghulam Murtaza et al.
✦ AI-curated · Sources linked
Case in brief
A woman in her 40s presented with progressive multisystem disease, including chronic distal neuropathy, constitutional decline, lymphadenopathy, and serosal effusions. Initial evaluations suggested tuberculosis, but further investigations revealed biclonal lambda-restricted paraproteinaemia and mixed axonal demyelinating polyneuropathy. An excision biopsy confirmed Castleman disease, leading to a diagnosis of POEMS syndrome. The patient was treated with daratumumab, bortezomib, and dexamethasone, followed by autologous stem cell transplantation, achieving biochemical remission.
What made this case unusual
The case illustrates the complexity of diagnosing POEMS syndrome in the context of Castleman disease and latent tuberculosis, which initially obscured the diagnosis.
Diagnostic / clinical pearl
Clinicians should consider POEMS syndrome in patients with multisystem disease, especially when accompanied by Castleman disease and atypical presentations.
Why it matters
Timely diagnosis of POEMS syndrome can mitigate the risk of further neurological damage, emphasizing the importance of thorough evaluation in complex cases.