VEGFA and Splenomegaly: Our patient exhibited a lambda-restricted predominant monoclonal gammopathy (MGUS) that later evolved to myeloma (Fig. 2), peripheral neuropathy, splenomegaly, high VEGF levels, recurrent pleural effusions, ascites with hypoalbuminemia and vascular leak, endocrine abnormalities with amenorrhea and hypothyroidism, and skin changes of mild hyperpigmentation but also multiple significant dermal ecchymotic lesions (Fig. 1).