CASE PRESENTATION: A man complaining of diarrhea, abdominal pain for 6 months was admitted to our hospital. There were bilateral axilla lymphadenectasis, unilateral hydrothorax and ascites. The TB-DNA test of bronchial alveolus lavage fluid and purified protein derivative of tuberculin (PPD) test were positive. A diagnosis of tuberculosis polyserositis was made and anti-TB therapy was administered. Diarrhea and abdominal pain were relieved to some extent, but two weeks was deteriorated. Drug-resistant tuberculosis was considered and second-line anti-TB drugs were prescribed, but ascitic and hydrothorax were not relieved. On endocrine testing, hypothyroidism was found. Serum protein electrophoresis showed an M-peak in the γ-fraction. A bone marrow study revealed that plasma cells accounted for 10-15%, and no atypical cells were seen. The lymphoglandula pathological biopsy demonstrated angiofollicular lymph node hyperplasia. The diagnosis of POEMS syndrome was established and chemotherapy was administered. After 3 months’ treatment, the ascites and hydrothorax were decreased.