Disclosures: Adetoluwa E. Ijidakinro, MD: No financial relationships or conflicts of interest

Case Description: A 52-year-old African American male with a known history of type 2 diabetes and glaucoma who presented with a 5 month history of progressive bilateral ankles, then bilateral shoulder weakness, and hand paresthesia. EMG showed demyelinating disease and conduction block consistent with advanced CIDP. Serology was consistent with SLE. The patient was started on immunosuppressive therapy with improvement of strength. However he was still unable to navigate stairs to enter his home and transferred to our institution to improve strength, ambulation and self care. During his stay, he developed bilateral hand stiffness, paresthesia, and worsening proximal muscle weakness with regression of self feeding and mobility from admission evaluation. He was then treated with a 3 day course of oral steroids.

Setting: Inpatient rehabilitation

Patient: Male Assessment/

Results: He progressed to contact guard assistance with wheelchair mobility, set up for feeding, and supervision for dressing and self care.

Discussion: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare neurological complication of Systemic Lupus Erythematosus (SLE). [1] Patients with CIDP present with symmetric proximal and distal weakness for at least 2 months, hyporeflexia or areflexia, nerve conduction abnormalities indicating demyelination[1]. Although the cause of CIDP is unknown, it can be associated with infectious disorders, diabetes mellitus, and autoimmune disease. An estimated 10%–20% of patients with systemic lupus erythematosus show peripheral nervous system involvement. However there is paucity of literature showing CIDP as initial presentation of SLE. Multiple factors, including early diagnosis of CIDP and presence of multiple antibodies associated with SLE, predict good response to intravenous immunoglobulin (IVIG). Although fatigue may be a barrier, rehabilitation has been shown to improve functionality of patients with polyneuropathy.

Conclusion: We present a rare case of CIDP as an initial presentation of SLE. Although the course varies, early diagnosis, treatment and rehabilitation is paramount to optimize mobility and self care for these patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cidp-as-an-initial-presentation-of-sle/