Clinical and Electrophysiological Profile of Neuropathy in POEMS Syndrome: Differentiation from Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

Background POEMS syndrome is a rare multisystem disorder associated with plasma cell dyscrasia and characterized by Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein, and Skin changes. Its neuropathic presentation often mimics chronic inflammatory demyelinating polyneuropathy (CIDP), resulting in diagnostic delays. Differentiating features are crucial for appropriate therapy and improved outcomes. Methods This retrospective observational study included 15 patients diagnosed with POEMS syndrome at a tertiary-care neurology center between January 2019 and October 2025. Diagnosis was based on Dispenzieri’s criteria, requiring polyneuropathy and a monoclonal plasma cell disorder with additional major and minor features. Clinical data, biochemical parameters, imaging findings, and nerve conduction studies were analysed to define the clinical and electrophysiological spectrum. Treatment response was assessed at three months post-therapy. Results The mean age was 44.9 ± 11.2 years, with slight male predominance. Organomegaly (87%), endocrinopathy (80%), and skin hyperpigmentation (93%) were common. Serum M-protein was demonstrable in 93% and osteosclerotic lesions in 80%. Electrophysiology revealed demyelinating neuropathy in 47%, mixed axonal–demyelinating in 27%, and axonal neuropathy in 20%. Lenalidomide–dexamethasone-based therapy resulted in neurological improvement in 87% of patients within three months. Conclusion Neuropathy in POEMS syndrome typically demonstrates a mixed demyelinating–axonal pattern with systemic manifestations distinguishing it from CIDP. Early recognition and institution of plasma cell–directed therapy lead to favourable functional recovery.