POEMS syndrome physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]Sabawoon Mirwais, M.B.B.S, M.D.[3]

Common physical examination findings of POEMS syndrome include, organomegaly (hepatomegaly, splenomegaly), peripheral edema/anasarca, ascites, mixed lytic/sclerotic bone lesions, papilledema, skin hyperpigmentation and lymphadenopathy.

• Anasarca or ascites may be present.

• Vital signs of patients with POEMS syndrome are usually normal.

• Hyperpigmentation
• Nail clubbing
• Leuconychia
• Thickening of the skin^[1]
• Excess hair or hair in unusual places (hypertrichosis)
• Skin angiomas or haemangiomas^[1]
• There may be changes reminiscent of scleroderma

• Papilledema
• Uveitis and preretinal haemorrhage may be present.

• Lymphadenopathy

• Pleural effusion (decreased or absent breath sounds, decreased tactile fremitus, dullness to percussion)

• Pericardial effusion (muffled heart sounds, jugular venous distension)

• Hepatomegaly
• Splenomegaly
• Ascites (succession splash, shifting dullness)

• Back examination of patients with POEMS syndrome is usually normal.

• Genitourinary examination of patients with POEMS syndrome is usually normal.

• Symmetrical, ascending chronic progressive polyneuropathy with both sensory (pin-prick and vibration) and motor disability (motor > sensory)
• Decreased muscle strength^[1]
• Absent deep tendon reflexes^[1]
• Impaired temperature, position, and vibration senses^[1]

• Bones may have sclerotic, lytic with sclerotic rims or mixed sclerotic/lytic lesions with soap-bubble appearance.

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