{
  "abstract": "One might expect the diagnosis of Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, Skin lesions (POEMS) syndrome to be relatively straightforward. By the time of diagnosis, patients often exhibit a multitude of classical diagnostic features, and at a relatively late-stage presentation, few other diseases look anything like it. In reality, things are often more complex. Patients develop seemingly unrelated symptoms insidiously. Neuropathy symptoms are often overlooked by patients, and then by doctors, at least initially. Once neurophysiology is performed, slowed conduction velocity is often reported as ‘demyelination’, and more misleadingly, ‘Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). Non-specific endocrine symptoms of fatigue, weight change, loss of libido and mood disturbance can be dismissed as symptoms of ageing or stress. Diabetes and thyroid dysfunction are so common that their identification does not prompt thoughts of a broader search. The discovery of a lambda-restricted paraprotein might help, but most laboratories still will not perform a serum immunofixation unless a paraprotein is identified by electrophoresis. In POEMS, there is no immunoparesis, and the absolute level is frequently too small to quantitate, resulting in it being missed. In most cases, a diagnosis of POEMS syndrome is made by an astute clinician conducting a thorough examination, identifying tell-tale characteristic features, and having knowledge that these seemingly unrelated symptoms and signs are explained by one unifying pathogenesis.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuromuscular Disease, Royal London Hospital, Barts Health NHS Trust, London, England, UK"
      ],
      "name": "Stephen Keddie"
    },
    {
      "affiliations": [
        "Department of Neuromuscular Diseases, Queen Square Institute of Neurology, University College London, London, UK",
        "Department of Neuroinflammation, National Hospital of Neurology and Neurosurgery, UCL Institute of Neurology, London, UK"
      ],
      "name": "Michael P Lunn"
    }
  ],
  "title": "Poetry in practice",
  "uid": "9d12f254-edf6-5c04-ba8a-6015bb3e88b7"
}