Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 1
Disclosures: Sindhoori R. Nalla, DO, MHSA: Nothing to disclose
Case Description: A 67-year-old female with history of AML necessitating prior HSCT infusions presented 3 months after her most recent infusion, with insidious onset progressive weakness in bilateral hands and lower extremities. Symptoms worsened to the point where she was having difficulty with fine motor control with inability to stand or ambulate. MRI brain and spine were unrevealing. Nerve conduction studies of bilateral upper and lower extremities revealed generalized acquired demyelinating polyneuropathy. Needle EMG studies were not possible due to thrombocytopenia. Given the clinical and electrodiagnostic findings, she was diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP), and due to time course of presentation, was likely a consequence of HSCT. She received intravenous immunoglobulin (IVIG) therapy for 2 days and was admitted to AIR at total assistance level. She received additional doses of IVIG which, along with physical and occupational therapy, improved her distal weakness. She was ultimately discharged home at minimal to moderate assistance level.
Setting: Acute Inpatient Rehabilitation (AIR)
Patient: 67-year-old female with acute myeloid leukemia (AML) status post hematopoietic stem cell transplant (HSCT)
Assessment/Results: Development of CIDP was likely due to HSCT for AML treatment. Symptoms improved with IVIG administration and extensive therapies.
Discussion: CIDP after HSCT in AML is a very rare phenomenon with published incidence of about 1-4%. Diagnosis is often delayed given variable clinical presentation and time course. It is imperative for physiatrists to consider this in their differential in individuals with progressive weakness following HSCT for AML treatment. While not well understood, some theories include development of neuropathy in setting of graft versus host disease. Treatment typically includes corticosteroids or immunoglobulins, while plasmapheresis can be used for those who do not respond to standard treatment.
Conclusion: This case highlights a rare consequence of HSCT in AML that can be seen in our cancer rehabilitation population.
Level of Evidence: Level V
To cite this abstract in AMA style:Nalla SR, Spill G. A Rare Case of Progressive Weakness Following Stem Cell Transplantation [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/a-rare-case-of-progressive-weakness-following-stem-cell-transplantation/. Accessed July 30, 2021.
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