ABSTRACT
Introduction: POEMS syndrome is a rare paraneoplasticsyndrome that can often be mistaken for other neurologicdisorders.Case Report: A 48-year-old gentleman presented withprogressive mixed motor and sensory neuropathy involvinglower limbs, with generalized hyperpigmentation andbilateral pitting pedal edema. Neurological examinationshowed symmetrical wasting involving both proximaland distal groups of muscles of lower limbs, decreasedpower (Grade 4/5) of the lower limbs with weakness beingmore severe distally, generalized areflexia, absence ofvibration sense and proprioception over the lower limbs andgraded sensory loss over the dorsum of both feet. Workupshowed a demyelinating sensorimotor polyneuropathy onnerve conduction velocity study and albuminocytologicaldissociation in CSF. After inconclusive initial evaluation, aPET CT was done which picked up an FDG avid lytic lesionin the L1 vertebra, and lymphadenopathy, and an MRI LSspine confirmed an expansile lesion with ""Mini brain sign"",indicative of plasmacytoma. Serum free light chain ratio andserum protein electrophoresis were normal. Bone marrowshowed no evidence of marrow involvement. Consideringthe constellation of findings of demyelinating sensorimotorpolyneuropathy, lymphadenopathy, peripheral edema anda solitary plasmacytoma, the possibility of a rare variant ofPOEMS syndrome with an osteolytic lesion was thought of.The lesion was biopsied and proven to be a plasmacytoma.The patient responded well to localized radiation therapy tothe lesion, along with intravenous steroids.Conclusion: A subacute symmetric sensorimotor neuropathymay be a presentation of POEMS syndrome. There can be rareinstances of a lytic lesion on radiography in POEMS"