A 46-year-old man with polyneuropathy, hepatosplenomegaly, endocrinopathy,monoclonal gammopathy, skin changes, sclerotic bone lesions and refractoryascites

The POEMS syndrome is a rare multisystemic disorder with polyneurppathy. or ganomegaly. endocrinopathy of various forms, production of monoclonal (M) c omponent, and skin changes. We describe a 46-year-old man who developed asc ites one year after the onset of peripheral neuropathy with accompanying mu scle atrophies and increasing weakness. Extensive evaluation revealed that the patient had no underlying liver disease, malignancy. infection, or card iac or renal disease. The ascites initially responded to high-dose corticos teroid therapy. The patient had many clinical features of the described POE MS syndrome: Including sclerotic bone lesions. a persistent lambda-paraprot ein and refractory ascites. In this case ascites was a main presenting feat ure. Thus, the POEMS syndrome must be added to the list of rare causes of r efractory ascites.