143 POEMS syndrome presenting with arterial and venous thromboses and cardiac tamponade

POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein level, and skin changes) syndrome is a rare multisystem, autoinflammatory condition resulting from underlying plasma cell neoplasm. Arterial and venous thromboses, in addition to third space oedema may be under-recognised features of the disease.We present the case of a 62 year old man with a progressive subacute distal symmetrical sensorimotor neuropathy with concurrent TIAs, pleural effusions and cardiac tamponade necessitating pericardial drainage. NCS confirmed severe sensorimotor demyelinating polyneuropathy. CSF was acellular with raised protein. Immunofixation demonstrated a monoclonal IgA Lambda band and VEGF levels were over 10,000pg/ml. CT-guided biopsy of an L1 osteosclerotic lesion showed an increased number of plasma cells. MRI brain with contrast revealed diffuse pachymeningeal enhancement and a CT venogram confirmed incidental venous sinus thrombosis. He was commenced on chemotherapy, as well as antiplatelet and anticoagulation agents as treatment for his cerebrovascular complications.High rates of venous and arterial thrombotic events occur in patients with POEMS. Whilst lower limb oedema is a characteristic finding, other forms of extravascular volume overload can occur such as pericardial and pleural effusions. This case highlights the importance of recognition and management of these features and complications of POEMS, to aid in both diagnosis and management.rachaelmatthews1990@gmail.com