POEMS syndrome physical examination
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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]
Overview
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.
Physical Examination
Appearance
Vital Signs
- Vital signs of patients with POEMS syndrome are usually normal.
Skin
- 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
HEENT
- Papilledema
- Uveitis and preretinal haemorrhage may be present.
Neck
Lungs
- Pleural effusion (decreased or absent breath sounds, decreased tactile fremitus, dullness to percussion)
Heart
Abdomen
- Hepatomegaly
- Splenomegaly
- Ascites (succession splash, shifting dullness)
Back
- Back examination of patients with POEMS syndrome is usually normal.
Genitourinary
- Genitourinary examination of patients with POEMS syndrome is usually normal.
Neuromuscular
- 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]
Extremities
- Bones may have sclerotic, lytic with sclerotic rims or mixed sclerotic/lytic lesions with soap-bubble appearance.