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.