Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 1
Disclosures: Jose O. Malave, MD: Nothing to disclose
Case Description: Over a 2-year period, a 29-year-old previously healthy male developed progressive low back/hip pain and proximal muscle weakness resulting in impaired mobility and reliance on a wheelchair for ambulation. One year of intermittent steroid treatments were unsuccessful and he gradually developed worsening pain, depression, anxiety, and insomnia and had significant difficulty performing his job. Further workup revealed multiple stress fractures and a right middle fossa phosphaturic mesenchymal tumor. He was admitted to inpatient rehab (IPR) after his meningioma resection, was total assist in ambulation on admission, and was reliant on oxycodone for chronic muscular pain. He was given daily comprehensive psychological support, started on an aggressive physical and occupation therapy program of increasing intensity, his myofascial pain was treated with nightly cyclobenzaprine and topical diclofenac, and he was educated on proper sleep hygiene.
Setting: Inpatient Rehabilitation (IPR) Facility
Patient: 29-year-old male high school teacher with a history of tumor induced osteomalacia and pathologic fractures secondary to a phosphaturic mesenchymal tumor.
Assessment/Results: His muscle strength recovered quickly and he was soon weaned off of all opioids. Anxiety and depression dramatically improved without the need for antidepressive medication and his insomnia completely resolved. He was discharged from inpatient rehab after 3 weeks, successfully returned to work thereafter, and has been fully independent since discharge from IPR.
Discussion: Tumor induced osteomalacia is a rare paraneoplastic syndrome resulting from phosphaturic mesenchymal tumors. To our knowledge, there have been no previously published cases focusing on the acute rehabilitation of patients with tumor induced osteomalacia from phosphaturic mesenchymal tumors.
Conclusion: Comprehensive inpatient rehabilitation can be an effective treatment for chronic debilitation from tumor induced osteomalacia and can result in significant functional gains in a short period of time.
Level of Evidence: Level V
To cite this abstract in AMA style:Malave JO, Berry K. A Rare Case of Tumor-induced Osteomalacia and Debility in a Young, Healthy Male: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/a-rare-case-of-tumor-induced-osteomalacia-and-debility-in-a-young-healthy-male-a-case-report/. Accessed July 30, 2021.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-rare-case-of-tumor-induced-osteomalacia-and-debility-in-a-young-healthy-male-a-case-report/