Disclosures: Kelly M. Brander, DO: No financial relationships or conflicts of interest
Case Description: Patient presented to acute care with weeks of fevers, malaise, joint pain, and weakness. Physical Medicine & Rehabilitation (PM&R) consultation for disposition planning noted to have profound weakness, with a proximal greater than distal gradient and significant shoulder and hip pain. He was previously modified independent for ADLs and mobility and required dependent care on initial evaluation. The clinical presentation did not fit with his known diagnosis of CIDP, which had been stable for many years. Per recommendations of PM&R consultation, investigation into a new neuromuscular process was pursued.
Setting: Large Academic Acute Care Hospital
Patient: 86 year-old male with complex medical history notable for chronic inflammatory demyelinating polyneuropathy (CIDP) Assessment/
Results: Infectious and inflammatory workup was only notable for elevated erythrocyte sedimentation rate and C-reactive protein and patient failed IVIG treatment. Autoimmune pane was negative and CK was normal. Extensive imaging was only notable for quadriceps muscle edema. Electromyography and muscle biopsy showed no evidence for myositis, but instead were consistent with a myopathy and Type 2 fiber atrophy, respectively. The patient was started on prednisone for presumed polymyalgia rheumatica (PMR) and his symptoms rapidly resolved. Patient subsequently returned to his baseline functional status and was discharged home.
Discussion: Although this patient presented with classic symptoms of PMR, his pre-existing neurologic disorder complicated the clinical picture. Proper diagnosis for this patient was dependent on strong clinical examination and communication among medical providers and ultimately led to proper treatment and essentially complete resolution of symptoms.
Conclusion: This case demonstrates the importance of cohesive interdisciplinary coordination of care and pursuit of additional diagnostic testing to ensure complete evaluation in a patient with a complex neurologic history that ultimately led to an excellent clinical outcome.
Level of Evidence: Level V
To cite this abstract in AMA style:
Brander KM, Farr EM, Goodman DA. Diagnosis of Acute Polymyalgia Rheumatica in a Patient with Chronic Inflammatory Demyelinating Polyneuropathy [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/diagnosis-of-acute-polymyalgia-rheumatica-in-a-patient-with-chronic-inflammatory-demyelinating-polyneuropathy/. Accessed May 14, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/diagnosis-of-acute-polymyalgia-rheumatica-in-a-patient-with-chronic-inflammatory-demyelinating-polyneuropathy/