Paula David MD, Ora Shovman MD, Yehuda Shoenfeld MD FRCP MaACR
Polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma-cell disorder, and skin changes (POEMS syndrome) is a rare multisystem paraneoplastic disorder driven by a plasma-cell dyscrasia and cytokine overproduction. It is often misdiagnosed as chronic inflammatory demyelinating polyneuropathy (CIDP) due to overlapping neuropathy [1]. Although thrombocytosis is typical, immune thrombocytopenia is a rare and underrecognized presentation. We describe a patient with longstanding immune thrombocytopenic purpura (ITP) that evolved to POEMS, developed sinusoidal obstruction syndrome (SOS) after an autologous stem-cell transplantation (ASCT), and remained cytopenic due to hypersplenism, highlighting diagnostic and therapeutic challenges.