a 39 year old woman presented with polyneuropathy hepatomegaly splenomegaly endocrinopathy monoclonal protein and skin changes several of the many clinical features of the recently described poems syndrome in addition she had a castleman s disease angiofollicular lymph node hyperplasia in this case ascites was a main presenting feature thus the poems syndrome must be added to the list of rare causes of ascites electron microscopy of the liver showed perisinusoidal fibrosis.