POEMS syndrome: two cases for the general physician.

Set in a district general hospital, this case series explores two individuals who developed a rare multisystemic syndrome; Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin abnormalities (POEMS). Diagnostic journey, trajectory of disease and outcomes are compared. Both patients presented to healthcare numerous times and saw multiple specialists for symptoms resulting predominantly from volume overload and neuropathy, prior to being admitted with atypical ischaemic stroke. During their admission, diagnosis was made after atypical intracranial arterial stenoses, sensory neuropathy not in-keeping with their stroke, plasmacytoma detection and confirmatory raised vascular endothelial growth factor (VEGF) levels. POEMS is highly treatment-responsive, survival rate improving with earlier diagnosis. Both patients transferred to specialist centers for chemotherapy. Unfortunately, patient outcomes significantly differ, one having favourable recovery, whilst the other suffering treatment-resistance disease requiring local repatriation for withdrawal of care. We identify challenges faced by both patients' and medical team and discuss the importance of the general physician within the world of specialist medicine, in order to provide holistic, comprehensive patient care.