Unmasking POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Gammopathy, and Skin Changes) Syndrome in a Heart Failure Patient: A Diagnostic Challenge

POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome remains poorly understood. It is a paraneoplastic syndrome caused by underlying plasma cell dyscrasia, and there is uncertainty about the features required to establish the diagnosis, treatment efficacy, and prognosis. Almost all patients have polyneuropathy or plasma cell disorder, and approximately one-third have Castleman's disease. Peripheral neuropathy often serves as the primary presenting complaint. While extensive discussions exist regarding POEMS syndrome diagnosis and treatment advancements, literature reports of heart failure symptoms associated with POEMS syndrome are scarce. In this article, we present a case of newly diagnosed POEMS syndrome in a 47-year-old man who initially presented with bilateral lower extremities edema and weakness. Although the initial workup was suggestive of heart failure, subsequent evaluation revealed monoclonal gammopathy, sclerotic bone lesions, and Castleman's disease, ultimately leading to the diagnosis of POEMS syndrome.