A rare case of POEMS syndrome with unique endoscopic presentation.

POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, Skin changes) syndrome is a rare multisystem disease, often presenting diagnostic challenges. Here, we report a case of POEMS syndrome in an elderly patient with refractory peritoneal effusion and hypoalbuminemia as the main manifestations. Physical examination revealed cutaneous hyperpigmentation of upper and lower extremities. Tests revealed elevated vascular endothelial growth factor (VEGF) and hypogonadism, while imaging showed enlargement of armpits and groin lymph nodes. Lymph node biopsy excluded tuberculosis and malignancy. Electroneuromyography (EMG) disclosed polyneuropathy of the lower extremities. Finally, he was diagnosed with POEMS syndrome via bone marrow biopsy. Notably, he presented endoscopic snakeskin-like appearance of stomach, which was consistent with previous research. POEMS syndrome, a rare cause of ascites, is frequently missed or misdiagnosed. Thus, clinicians should maintain high vigilance. In patients with unexplained refractory ascites and symptoms like neuropathy, lymph nodes enlargement, and endocrine disorders, screening for VEGF levels and M protein should be performed to facilitate early identification of POEMS syndrome.