The POEMS syndrome is a rare multisystemic disorder with polyneuropathy, 
organomegaly, endocrinopathy of various forms, production of monoclonal (M) 
component, and skin changes. We describe a 46-year-old man who developed ascites 
one year after the onset of peripheral neuropathy with accompanying muscle 
atrophies and increasing weakness. Extensive evaluation revealed that the 
patient had no underlying liver disease, malignancy, infection, or cardiac or 
renal disease. The ascites initially responded to high-dose corticosteroid 
therapy. The patient had many clinical features of the described POEMS syndrome 
including sclerotic bone lesions, a persistent lambda-paraprotein and refractory 
ascites. In this case ascites was a main presenting feature. Thus, the POEMS 
syndrome must be added to the list of rare causes of refractory ascites.