Disclosures: Chanel I. Davidoff, DO: No financial relationships or conflicts of interest

Case Diagnosis: Chemotherapy Induced Lumbosacral Radiculoplexus Neuropathy

Case Description: A 70-year-old female with a history of breast cancer presented with progressive lower extremity weakness. This patient presented following docetaxel and cyclophosphamide chemotherapy with bilateral lower extremity pain and asymmetrical weakness. The weakness progressed to paraplegia, requiring wheelchair use. Associated symptoms included numbness without bowel or bladder dysfunction.

Setting: Outpatient Physiatry PracticeAssessment/

Results: Work up with MRI lumbar spine and pelvis revealed no metastatic disease or mass compression on the lumbosacral plexus. PET scan was negative for disease progression. CT head, lumbar puncture, and paraneoplastic autoantibody panel were negative. Electrodiagnostic evaluation demonstrated evidence of lumbosacral plexopathy of uncertain etiology. The patient was treated with a trial of steroid infusions from neurology with minimal improvement. Second opinion from a nationally renowned neuromuscular specialist suggested lumbosacral plexopathy in the setting of pre-diabetes (A1c 6.1%) and chemotherapy, with good prognosis and slow recovery. Over a matter of months, the patient progressed from wheelchair to rolling walker, and then quad cane with orthoses.

Discussion: Lumbosacral Radiculoplexus Neuropathy (LRPN) is characterized by slowly progressive, asymmetrical lower extremity pain and weakness resulting in disability. It was originally described in diabetic patients as “diabetic amyotrophy” but has been recognized in the non-diabetic population through similar mechanisms, namely, ischemic injury leading to microvasculitis changes to the plexus and peripheral nerve. To our knowledge, this is the first reported case of LPRN induced by chemotherapy.

Conclusion: LRPN is an uncommon effect of chemotherapy but should be considered as a differential diagnosis if classic chemo-induced peripheral neuropathy, metastatic disease, and other etiologies have been ruled out. Exposure to anti-neoplastic agents, in the setting of pre-existing conditions such as smoking or diabetes, can predispose nerves to further damage leading to various neuropathic presentations. It is important for physiatrists to consider medical co-morbidities when treating patients with neuromuscular conditions in oncological rehabilitation.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/not-your-average-neuropathy-an-unusual-case-of-paraplegia-due-to-lumbosacral-radiculoplexopathy-in-a-patient-treated-for-breast-cancer/