POEMS-A Diagnostic Odyssey

POEMS syndrome is a rare multisystem paraneoplastic disease that manifests with a spectrum of symptoms namely peripheral neuropathy (P), organomegaly (O), endocrinopathy (E) monoclonal plasma-cells proliferative disorder (M) and skin changes (S). This case report presents an elderly lady who presented with unexplained quadriparesis. Nerve conduction studies suggested peripheral neuropathy. Atypical lymphocytes on the peripheral smear led to the suspicion of a hematological malignancy with peripheral neuropathy presenting as a paraneoplastic syndrome. Bone marrow biopsy confirmed the diagnosis of plasma cell myeloma. The combined presence of myeloma with peripheral neuropathy led to the consideration of POEMS syndrome. This patient also presented with an unexplained persistent hypokalemia with metabolic alkalosis with normal renal function tests and thus, a Gitelman like syndrome was considered. This case report accentuates the plethora of symptoms that characterize POEMS and also highlights the extremely rare association of acquired Gitelman-like syndrome with POEMS syndrome