POEMS syndrome.
A middle-aged man presented with progressive dyspnea and a pleural effusion. He had slowly progressive bilateral symmetric extremity weakness, mediastinal lymphadenopathy, and splenomegaly. The diagnosis of POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M-Protein and Skin changes was suspected clinically and confirmed with a bone marrow biopsy. He responded symptomatically to corticosteroids and is awaiting a stem cell transplant.