POEMS syndrome is a rare conglomeration of disorders associated with plasma cell 
dyscrasia. The acronym POEMS is derived from main features of the syndrome 
namely 'polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and 
skin lesions'. Other clinical features include presence of sclerotic bone 
lesions, Castleman's disease, papilledema, pleural effusion, edema, ascites, 
erythrocytosis and thrombocytosis. Myeloma is the most common plasma cell 
dyscrasia associated with POEMS syndrome. Renal involvement is rare and renal 
biopsy is characterized by glomerular involvement with membranoproliferative 
glomerulonephritis and endothelial injury. We report a case of a 67-year-old 
male who presented with clinical features satisfying the diagnostic criteria of 
POEMS syndrome and had rapidly progressive renal failure. Renal biopsy showed 
extensive interstitial infiltration by plasma cells and concomitant presence of 
classic polyarteritis nodosa. Although association with small-vessel vasculitis 
has been reported in patients with POEMS syndrome, to the best of our knowledge, 
this is the first report of POEMS syndrome associated with medium-sized vessel 
vasculitis.