Multidisciplinary Intensive Care Management of Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal Protein, and Skin Changes (POEMS) Syndrome: A Case Report

Abstract

We present the case of a 65-year-old man with long-standing polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome, who developed progressive multi-organ dysfunction requiring support in the intensive care unit (ICU). The patient's course was complicated by nodular regenerative hyperplasia (NRH) contributing to non-cirrhotic portal hypertension and severe ascites, acute kidney injury (AKI), hemodynamic instability, and endocrine abnormalities. Management involved multidisciplinary coordination across critical care, hematology, nephrology, and endocrinology teams, with prophylactic antimicrobial therapy, careful hemodynamic optimization, and individualized nutritional and endocrine support. This case highlights the complexity of ICU management in POEMS syndrome, demonstrating the importance of early recognition, collaborative care, and tailored interventions in optimizing outcomes for critically ill patients.

Keywords: acute kidney injury; hemodynamic instability; multiorgan dysfunction; nodular regenerative hyperplasia; poems syndrome; portal hypertension.