POEMS syndrome misdiagnosed as liver cirrhosis: a case report

POEMS syndrome is a rare multisystem paraneoplastic disorder characterized by polyneuropathy and monoclonal plasma cell proliferation, often leading to delayed diagnoses due to variable clinical manifestations. A 62-year-old woman presented with persistent bilateral eyelid edema as the initial symptom and abdominal distension as the predominant complaint. She was misdiagnosed with liver cirrhosis and remained undiagnosed for 6 years. Multidisciplinary evaluation revealed monoclonal IgA λ protein, markedly elevated vascular endothelial growth factor, and neurophysiological evidence of peripheral neuropathy, consistent with POEMS syndrome. Treatment with lenalidomide and dexamethasone, along with supportive care, led to improvement in abdominal distension and bilateral lower limb edema. This case underscores the need to consider POEMS syndrome in patients with unexplained eyelid edema accompanied by multisystemic manifestations. Given its potential to mimic other conditions, such as cirrhosis-as highlighted by this patient's prolonged misdiagnosis-prompt and accurate recognition is essential to guide appropriate management, prevent irreversible organ damage, and improve long-term outcomes.