POEMS syndrome combined with diffuse proliferative glomerulonephritis: A case report and literature review

Objective To deepen the understanding of multi-system damage caused by POEMS (polyneuropathy,organomegaly,endocrinopathy,M protein elevation,and skin changes syndrome) in clinical practice by reporting a POEMS syndrome patient with diffuse proliferative glomerulonephritis. Methods Clinical data about one POEMS syndrome patient with diffuse proliferative glomerulonephritis admitted to Liyuan Hospital in October 2,2018 were retrospectively analyzed and related literatures were reviewed. Results The case was a 70 year-old man with edema and hypertension for 5 months.Simultaneously,symptoms including multiple lymphadenopathy,osteosclerosis,serosal effusion,double M proteinemia,and Bence-Jones proteinuria were also found in this patient.Histopathological findings of kidney and lymph nodes indicated diffuse proliferative glomerulonephritis and transparent vascular Castleman disease,respectively.Initially,the patient was misdiagnosed as Castleman's disease combined with diffuse proliferative glomerulonephritis,and then he was treated with thalidomide.However,the symptoms did not improve significantly.Subsequently,pericardial effusion and weakness of both lower limbs appeared.Then we reviewed related literatures,and realized that it might be POEMS syndrome which we neglected before.Further tests revealed peripheral neuropathy and increased vascular endothelial growth factor (VEGF,1 423.08 pg/ml↑),confirming the diagnosis of POEMS syndrome.After given RCOP (rituximab +cyclophosphamide + vinorelbine + prednisone) chemotherapy for 6 months,the symptoms were significantly improved,and VEGF level decreased. Conclusion Glomerulonephritis caused by POEMS syndrome is rare and prone to occur in patients with Castleman disease.Therefore,POEMS syndrome should not be overlooked on the basis that kidney damage and Castleman disease coexist.