Lenalidomide Treatment for a POEMS Syndrome Patient with Massive Pericardial Effusion as the First Manifestation

Abstract

To show the successful handle of a very rare complication of POEMS syndrome. We report a case of POEMS syndrome wherein the first symptom was recurrent massive pericardial effusions. The patient was misdiagnosed as having tuberculous pericarditis and received anti-tuberculosis treatment for nearly 20 months without effect. She suffered painful pericardiocentesis every 2 to 3 months until the POEMS syndrome diagnosis was confirmed when she appeared with polyneuropathy combined with cervical lymph node biopsy, indicating Castleman disease, serum monoclonal immunoglobulin of IgG λ type, and markedly elevated serum VEGF. Lenalidomide and dexamethasone treatments were introduced, and her pericardial fluid significantly reduced. Massive pericardial effusion is a rare manifestation of POEMS syndrome. POEMS syndromes with polyserositis are easily misdiagnosed as tuberculous polyserous effusions in China. Recognition of the possible pathogenesis of POEMS syndrome with a large amount of pericardial effusion will help to identify POEMS syndrome in an early stage.