Disclosures: Melanie White, DO: No financial relationships or conflicts of interest

Case Diagnosis: Acute sensory motor axonal neuropathy (ASMAN)

Case Description or Program Description: A 16-year-old-male was admitted to the hospital with acute onset pain, paresthesias, and gait dysfunction 57 days after haploidentical allogenic bone marrow transplant (alloBMT) for recurrent acute myelogenous leukemia (AML). His respiratory condition acutely worsened, necessitating intubation. Magnetic resonance imaging of the spine demonstrated spinal cord enhancement along the cauda equina. Electromyography/nerve conduction study showed diffuse, subacute, severe neuropathic and myopathic processes compatible with a progressing polyradiculoneuropathy and superimposed proximal myopathy corresponding to tetraparesis. Cerebral spinal fluid studies revealed characteristic albuminocytologic dissociation leading to the diagnosis of ASMAN.

Setting: Inpatient rehabilitation

Assessment/Results: The patient received four rounds of plasmapheresis with rituximab. He was admitted to inpatient rehabilitation, once respiratory status improved, to address residual, lower extremity motor deficits. At dismissal, he was ambulating short distances with bilateral ankle/foot orthoses and a walker and performing independent transfers and most activities of daily living with minimal assistance.

Discussion (relevance): We believe this is the first reported case of ASMAN following haploidentical alloBMT for recurrent AML. ASMAN is a rare form of Guillain Barre Syndrome (GBS), especially in children. ASMAN presents with acute onset sensory symptoms, distal weakness, and rapid progression to paralysis, often requiring intubation within the first week of symptom onset. Timeline and amount of sensorimotor recovery are variable, often with incomplete recovery. This patient’s timeline of symptom onset, rapid respiratory deterioration, and slow recovery of sensorimotor functioning is consistent with other cases of ASMAN.

Conclusions: This case highlights the key clinical characteristics of ASMAN, a rare and severe form of GBS. This patient presented with acute sensory symptoms, distal weakness, and rapid clinical decline. It is vital for both rehabilitation and non-rehabilitation providers to include this GBS variant in differential diagnoses for patients presenting with acute paresthesias and weakness, so as not to delay diagnostic workup and treatment.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-sensory-motor-axonal-neuropathy-as-possible-complication-of-haploidentical-allogenic-bone-marrow-transplant-for-recurrent-acute-myelogenous-leukemia-a-case-report-and-literature-review/