A 52-year-old man presents with progressive symmetric distal weakness and numbness of two years' duration. Examination also shows gynaecomastia and pedal edema. Skeletal survey reveals a single osteosclerotic lesion in the left ilium. Serum VEGF level is markedly elevated. Bone marrow shows 4% plasma cells and serum electrophoresis shows a small lambda-restricted band. The most likely diagnosis is:

• A Multiple myeloma with paraneoplastic neuropathy
• B POEMS syndrome associated with an osteosclerotic plasmacytoma ✓
• C AL amyloidosis with peripheral nerve infiltration
• D Chronic inflammatory demyelinating polyneuropathy with monoclonal gammopathy of undetermined significance

Explanation

Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin changes define POEMS syndrome, which is driven by clonal plasma cells secreting VEGF and typically accompanies osteosclerotic rather than lytic lesions. Plasma cells are usually below 10 percent, distinguishing it from myeloma. AL amyloidosis causes renal and cardiac involvement rather than this constellation, and CIDP with MGUS lacks osteosclerotic lesions, organomegaly, endocrine dysfunction, and raised VEGF.

Reference: Williams Hematology, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.