Síndrome de POEMS asociado a la enfermedad de Castleman: Reporte de caso

Abstract

Introduction: POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, and Skin changes) is a rare paraneoplastic disorder affecting multiple systems. Its diagnosis is particularly challenging due to the variety of clinical manifestations and its low prevalence. On the other hand, Castleman disease is a lymphoproliferative disorder of unknown origin that is frequently associated with POEMS, leading to greater complexity in the management of affected patients. The coexistence of these two conditions not only worsens the prognosis but also presents significant therapeutic challenges, as their combination requires a multidisciplinary approach to early diagnosis and the implementation of appropriate treatments. Objective: To present a clinical case of POEMS syndrome associated with Castleman disease. Case Presentation: An 83-year-old patient with a history of hypertension, hypothyroidism, rheumatoid arthritis, and Castleman disease initially presented with polyarthralgia, weight loss, and paresthesia in the lower limbs. Subsequent studies revealed polyneuropathy, a proliferative disorder of monoclonal plasma cells, sclerotic bone lesions, organomegaly, endocrinopathy, and thrombocytosis. The diagnosis of POEMS syndrome was confirmed, and treatment was initiated with chemotherapy (cyclophosphamide, melphalan, and dexamethasone), later transitioning to lenalidomide due to disease progression. The patient discontinued treatment due to side effects. Conclusion: The association between POEMS syndrome and Castleman disease presents considerable clinical challenges in diagnosis and treatment. This case highlights the importance of early diagnosis and a multidisciplinary therapeutic approach in these rare conditions.