{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T04:40:07Z","timestamp":1751949607229,"version":"3.41.2"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder, Skin changes) syndrome is a rare paraneoplastic disorder driven by a \u03bb-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 <jats:italic>Vibrio vulnificus<\/jats:italic> infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>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-\u03bb monoclonal band on serum immunofixation, and a markedly elevated VEGF level (729.7\u202fpg.\/mL, reference range: 9\u201386\u202fpg.\/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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Management and outcome<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case expands the spectrum of POEMS-associated skin changes to include <jats:italic>V. vulnificus<\/jats:italic>\u2013like bullous lesions. \u201c<jats:italic>V. vulnificus<\/jats:italic>\u2013like\u201d 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1625877","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T04:11:51Z","timestamp":1751947911000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["POEMS syndrome presenting with Vibrio vulnificus\u2013like cutaneous lesions: a CARE guidelines-compliant case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Xiaomei","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bihong","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liping","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Conghua","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1001\/jamaoncol.2021.0586","article-title":"Update on the diagnosis and treatment of POEMS (polyneuropathy, Organomegaly, Endocrinopathy, monoclonal Gammopathy, and skin changes) syndrome: a review","volume":"7","author":"Khouri","year":"2021","journal-title":"JAMA Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1038\/s41408-022-00661-1","article-title":"Cutaneous manifestations of monoclonal gammopathy","volume":"12","author":"Claveau","year":"2022","journal-title":"Blood Cancer J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1934","DOI":"10.1002\/ajh.27081","article-title":"POEMS syndrome: update on diagnosis, risk-stratification, and management","volume":"98","author":"Dispenzieri","year":"2023","journal-title":"Am J Hematol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3065","DOI":"10.1007\/s11606-023-08171-x","article-title":"Skin changes of POEMS","volume":"38","author":"Liu","year":"2023","journal-title":"J Gen Intern Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1038\/s41375-024-02489-z","article-title":"Capillary leak phenotype as a major cause of death in patients with POEMS syndrome","volume":"39","author":"Lee","year":"2025","journal-title":"Leukemia"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1136\/jnnp-2020-324012","article-title":"Early VEGF testing in inflammatory neuropathy avoids POEMS syndrome misdiagnosis and associated costs","volume":"92","author":"Marsh","year":"2021","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1093\/gpbjnl\/qzaf027","article-title":"Clonal hematopoietic mutations in plasma cell disorders: clinical subgroups and shared pathogenesis","author":"Wang","year":"2025","journal-title":"Genomics Proteomics Bioinformatics"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e70049","DOI":"10.1002\/hon.70049","article-title":"VEGF as a relapse marker and an intensity of disease marker in patients affected by POEMS syndrome treated with autologous peripheral blood stem cell transplantation","volume":"43","author":"Autore","year":"2025","journal-title":"Hematol Oncol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e518","DOI":"10.1111\/jdv.19712","article-title":"Specific dermoscopic findings in glomeruloid haemangioma for diagnosis of POEMS syndrome","volume":"38","author":"Otake","year":"2024","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1001\/jama.2023.0174","article-title":"What to know about Vibrio vulnificus","volume":"329","author":"Walter","year":"2023","journal-title":"JAMA"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1445971","DOI":"10.3389\/fmed.2024.1445971","article-title":"Case report: atypical POEMS syndrome without polyneuropathy, complicated by borderline TAFRO syndrome","volume":"11","author":"Tan","year":"2024","journal-title":"Front Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1136\/postgradmedj-2018-135860","article-title":"Cutaneous manifestations as a clue to the diagnosis of POEMS syndrome","volume":"94","author":"Kumar","year":"2018","journal-title":"Postgrad Med J"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1625877\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T04:11:52Z","timestamp":1751947912000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1625877\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,8]]},"references-count":12,"alternative-id":["10.3389\/fmed.2025.1625877"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1625877","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,8]]},"article-number":"1625877"}}