A case of recurrent pleural effusion: tuberculous pleurisy or other disease? A case report

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes) is a paraneoplastic syndrome caused by a plasma cell proliferative disorder. Although POEMS syndrome can cause polyserous effusions, the report of pleural effusion as the main manifestation is not common. Here, we describe a case of POEMS syndrome misdiagnosed as tuberculous pleurisy due to massive pleural effusion. A 70-year-old man was admitted with chest tightness and was diagnosed with tuberculous pleurisy. Despite receiving anti-tuberculosis treatment, patient exhibited ineffective responses and developed numbness in his lower limbs, indicative of an adverse drug reaction.Adjustment of medication and nutritional nerve treatment yielded no significant improvement. Then he was admitted for the second time three months later. Subsequent auxiliary examinations revealed positive M protein, elevated VEGF(vascular endothelial growth factor), peripheral neuropathy, and endocrine disorders, ultimately confirming the diagnosis of POEMS syndrome. POEMS syndrome can be mainly characterized by pleural effusion. When the cause of pleural effusion is unknown, POEMS syndrome should be suspected.