CASE REPORT article
Front. Med.
Sec. Dermatology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1625877
POEMS syndrome presenting with Vibrio vulnificus-like cutaneous lesions: a CARE guidelines-compliant case report
Provisionally accepted
- 1Putian University, Putian, China
- 2The First Affiliated Hospital of Nanchang University, Nanchang, China
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Background: POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder, Skin changes) syndrome is a rare paraneoplastic disorder driven by a λ-restricted plasma cell clone. Cutaneous manifestations are common but typically limited to hyperpigmentation, hemangiomas, and sclerodermoid changes. We herein report the first case of POEMS syndrome presenting with skin lesions closely resembling those of Vibrio vulnificus infection.Case Presentation: A 65-year-old woman was admitted with malignant hypertension, refractory ascites, symmetrical thigh ecchymoses evolving into tense hemorrhagic bullae, and progressive sensorimotor polyneuropathy. Laboratory workup revealed thrombocytosis, hypoalbuminemia, acute kidney injury, an IgA-λ monoclonal band on serum immunofixation, and a markedly elevated VEGF level (729.7 pg/mL, reference range: 9-86 pg/mL). Electromyography confirmed a demyelinating neuropathy. Infectious, autoimmune, hepatic, renal, and malignant etiologies were systematically excluded. A multidisciplinary team reached the diagnosis of POEMS syndrome based on two mandatory criteria (polyneuropathy and monoclonal plasma cell disorder), one major criterion (elevated VEGF), and multiple minor criteria (extravascular volume overload, endocrinopathy, skin changes, thrombocytosis, organomegaly).Management and Outcome: The patient received bortezomib plus dexamethasone, leading to gradual resolution of skin lesions, improvement of neuropathic symptoms, and reduction of VEGF levels. After six cycles, ascites resolved and neurological function partially recovered.Conclusion: This case expands the spectrum of POEMS-associated skin changes to include Vibrio vulnificus–like bullous lesions. “Vibrio vulnificus–like” refers purely to morphological similarity and not microbiological confirmation. Awareness of such atypical presentations is essential for early recognition. Clinicians should consider POEMS syndrome in patients with unexplained multisystem involvement and vascular skin changes. VEGF measurement and immunofixation electrophoresis are essential tools for timely diagnosis.
Keywords: POEMS Syndrome, Cutaneous manifestations, monoclonal plasma cell disorder, Vibrio vulnificus, case report
Received: 12 May 2025; Accepted: 24 Jun 2025.
Copyright: © 2025 Li, Lin, Lin and Song. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Conghua Song, The First Affiliated Hospital of Nanchang University, Nanchang, China
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