Abstract Introduction Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin Changes (POEMS) syndrome is a rare multisystem paraneoplastic disorder caused by an underlying plasma cell dyscrasia. Diagnostic criteria include the presence of polyneuropathy and monoclonal gammopathy, with other features including organomegaly, endocrinopathy, skin changes, papilledema, sclerotic bone lesions, and extravascular volume overload. Vascular endothelial growth factor (VEGF) is central to its pathogenesis and serves as a sensitive biomarker for diagnosis and disease monitoring. Due to its variable manifestations, POEMS syndrome is often underrecognized or attributed to other comorbidities, especially in transplant recipients. We report a case of POEMS syndrome in a patient following lung transplantation, emphasizing the diagnostic challenges in this complex clinical setting. Case Presentation A 56-year-old female who received a right lung transplant in July of 2024 initially presented from rehabilitation to the hospital for progressive dyspnea, weakness and worsening peripheral neuropathy. Neurology evaluation raised concern for acquired demyelinating polyradiculoneuropathy. Hematology was consulted for monoclonal gammopathy work up to rule out plasma cell dyscrasia or POEMS syndrome. Laboratory evaluation revealed elevated VEGF levels and vitamin B12 deficiency. Imaging demonstrated a possible sclerotic bone lesion. Additional features include papilledema, endocrinopathy, extravascular volume overload, digital clubbing, and restrictive lung physiology. Collectively, her findings met the diagnostic criteria for POEMS syndrome. Discussion This case underscores the importance of considering POEMS syndrome in transplant recipients with neuropathy and evidence of a plasma cell disorder. Plasma cell dyscrasia and features like neuropathy, volume overload, cytopenias, and endocrinopathies should be the target of therapy and may be mistakenly attributed to immunosuppressive therapy, opportunistic infection, or nutritional deficiencies. VEGF measurement was particularly useful in this case, as it is more sensitive and specific than M-protein burden or bone marrow findings for both diagnosis and disease monitoring. Early recognition of POEMS syndrome is critical, as hematologic therapy can meaningfully alter disease trajectory and improve functional outcomes1. This case highlights the necessity of a broad differential and multidisciplinary evaluation in post-transplant patients with complex presentations. Awareness of POEMS in such contexts can prevent misdiagnosis, facilitate timely treatment, and ultimately improve patient prognosis. References 1. Kuwabara S, Misawa S, Kanai K, et al. Neurologic improvement after peripheral blood stem cell transplantation in POEMS syndrome. Neurology. 2008;71(21):1691-1695. doi: 10.1212/01.wnl.0000335163.79672.26 This abstract is funded by: None
Patel et al. (Fri,) studied this question.