# Dramatically elevated plasma vascular endothelial growth factor levels from influenza A infection in polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome: A case report

## TL;DR

A patient with POEMS syndrome showed a significant rise in VEGF levels, likely due to influenza A rather than the disease itself.

## Contribution

This case highlights the potential for respiratory viral infections to mimic disease progression in POEMS syndrome through elevated VEGF.

## Key findings

- Plasma VEGF levels increased from 182 to 740 pg/mL during lenalidomide-dexamethasone therapy.
- Influenza A infection was identified as a likely cause of the VEGF elevation rather than disease progression.
- The case underscores the importance of monitoring VEGF levels and considering infections during POEMS treatment.

## Abstract

We present a patient with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome who had a dramatic and sustained elevation in plasma vascular endothelial growth factor (VEGF) levels from 182 to 740 pg/mL while on lenalidomide‐dexamethasone therapy. Given his biochemical evidence of progression, second‐line daratumumab was added. In hindsight, a concurrent influenza A infection was the likely driver of his VEGF elevation rather than his underlying POEMS syndrome. Given the importance of longitudinal VEGF monitoring and the infectious risks of plasma cell therapies, our case highlights the need for caution with POEMS response assessments in the setting of a respiratory viral infection.