POEMS syndrome: Two cases for the general physician.

Set in a district general hospital, this case series explores two individuals who developed a rare multisystemic syndrome:; polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin abnormalities (POEMS). Diagnostic journey, trajectory of disease and outcomes are compared. Both patients presented to healthcare numerous times and saw multiple specialists for symptoms resulting predominantly from volume overload and neuropathy, prior to being admitted with atypical ischaemic stroke. During their admission, diagnosis was made after atypical intracranial arterial stenoses, sensory neuropathy not in keeping with their stroke, plasmacytoma detection and confirmatory raised vascular endothelial growth factor (VEGF) levels. POEMS is highly treatment responsive, survival rate improving with earlier diagnosis. Both patients were transferred to specialist centres for chemotherapy. Unfortunately, patient outcomes significantly differ, one having favourable recovery, while the other experiencing treatment-resistance disease requiring local repatriation for withdrawal of care. We identify challenges faced by both patients and the medical team, and discuss the importance of the general physician within the world of specialist medicine, in order to provide holistic, comprehensive patient care.