POEMS syndrome associated with multiple hemangiomas of the small bowel and colon.

thy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. POEMS syndrome is a rare disor− der, with only a limited number of cases reported in the literature. The first de− scriptions of POEMS syndrome were pub− lished by Crow in 1956 [1] and by Fukase in 1968 [2]. It is therefore also known as Crow±Fukase syndrome. The symptom complex of POEMS syndrome includes skin changes such as hyperpigmentation, skin thickening, sclerodermoid changes, hypertrichosis, and hemangiomas [3]. Glomeruloid hemangiomas of the skin are thought to be specific to POEMS syn− drome and have been shown to affect one−third of patients [4]. A 59−year−old white man with known POEMS syndrome was admitted to our department. At the time of admission, he presented with gastrointestinal bleeding, melena, and general weakness. His hemo− globin concentration had dropped from 11.0 g/dL to 8.5 g/dL. The patient had received effective antico− agulation treatment with warfarin for permanent atrial fibrillation. Esophago− gastroduodenoscopy did not reveal rele− vant pathologic findings. Colonoscopy (CF−H180AI/L; Olympus Corp., Tokyo, Ja− pan) showed multiple hemangiomas 5 ± 10 mm in diameter scattered over the en− tire colonic mucosa (l" Fig. 1). In addi− tion, multiple polypoid hemangiomas of the mucosa of the jejunum and ileum were detected by small−bowel videocap− sule endoscopy (PillCam SB; Given Imag− ing Ltd., Yoqneam, Israel) (l" Video 1). This is the first report of a patient with POEMS syndrome in whom multiple mu− cosal hemangiomas of the small bowel and colon were found. We conclude that hemangiomas in POEMS syndrome are not only limited to the skin but may also occur in the gastrointestinal tract. This observation should be taken into account for future diagnostic measures in patients with suspected POEMS syndrome, espe− cially those patients at high risk of gastro− intestinal bleeding. Endoscopy_UCTN_Code_CCL_1AD_2AF