Patient initially presented to local GP in UAE (August 20) with bilateral lower limb pain and weakness. He was  treated with analgesia and Vitamin D injections. He subsequently developed left foot drop and worsening of numbness for which he was referred to Neurology. MRI LS spine showed minimal disc disease. MRI pelvis showed right inferior pubic ramus sclerotic lytic lesion. He was treated with methyl prednisolone and pregabalin. NCS & EMG from UAE showed severe demyelination poly-radiculo neuropathy lower limbs>upper limbs. He came back to Pakistan to pursue further treatment. Repeat investigations were done from Civil Hospital. Repeat NCS & EMG was suggestive of CIDP. CSF R/E showed cell-protein dissociation He had 05 cycles of plasma exchange but there was no response. He got second opinion from PEMH and was advised workup for CIDP. Bone Marrow Aspiration examination from Civil hospital was suggestive of MGUS.

Patient was referred to AFBMTC in 2021 with poly-Neuropathy, IgG lamda paraprotein and erythrocytosis and thrombocytosis. Neurological examination showed left foot drop, limping gait, power 4/5 Bilateral, absent knee and ankle reflexes. BMA was suggestive of MGUS. There was no evidence of end organ damage. Considering the Polyneuropathy, monoclonal gammopathy, thrombocytosis, Polycythemia and low B12 levels and exlusion of other causes, he was diagnosed as  POEMS Syndrome.  1x Phlebotomy done in Feb 2021 .Patient was given 1 x cycle of VCD. He had worsening of neuropathy and bortezomib was omitted from cycle 2. His neuropathy improved clinically and was able to walk with support, although foot drop persisted. He was worked up for Auto BMT.

He was transplanted on 23/7/2021 with Melphalan used as conditioning protocol.

Moiz experienced febrile neutropenia, acute transfusion reaction with Random donor platelets and GTC seizures during transplant period.

He was discharged after his condition stabilized and wad advised for weekly follow up in OPD.