Abstract: Objective To improve the understanding of POEMS syndrome and reduce the incidence of misdiagnosis. Methods 4 patients who were treated in our department from January 2017 to August 2019 were collected. According to the causes of the disease, clinical features and examination results, relevant misdiagnosis analysis and literature review of the above patients were conducted to summarize their characteristics. Results 1 case had peripheral nerve and other 3 cases had ascites or hepatosplenomegaly as the first symptom on admission. 3 cases were Ig A lamda positive, one was IgG lamda positive. The VEGF levels of them were higher than 800 pg/ml, and no fibrosis in liver tissue pathology. Conclusion POEMS syndrome is a multi-systemic disease with low incidence and high misdiagnosis rate. Hepatomegaly and splenomegaly with peritoneal effusion may be the first symptom of some patients with POEMS syndrome. Clinicians should pay attention to multi-system inspection to reduce misdiagnosis and improve clinical diagnosis rate.

Key words: POEMS syndrome, Peritoneal effusion, Organ enlargement, M protein, Liver tissue pathology