Beyond the Obstruction: Recognising Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Plasma Cell Disorder, and Skin Changes (POEMS) Syndrome in a Patient With Budd-Chiari Syndrome

Polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes (POEMS) syndrome is a rare paraneoplastic disorder caused by an underlying monoclonal plasma cell neoplasm. We report a rare case of a 52-year-old man who presented with subacute sensorimotor neuropathy, hepatosplenomegaly, ascites, pleural effusion, thrombocytosis, gynecomastia, and osteosclerotic bone lesions. Investigations revealed elevated vascular endothelial growth factor (VEGF) levels and clonal plasma cells, consistent with POEMS syndrome. He was also found to have hepatic vein thrombosis, confirming Budd-Chiari syndrome. Treatment with daratumumab, bortezomib, and dexamethasone, along with anticoagulation, led to good symptom control. This case highlights the diagnostic challenges and multisystem presentation of POEMS syndrome. Early identification and multidisciplinary management can help prevent irreversible complications.