Session Title: Neurological Rehabilitation Case and Research Report
Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 5
Disclosures: Brian M. Dena, DO: Nothing to disclose
Case Description: 65-year-old man presented with 1 month of progressive weakness, paresthesia, neuropathic pain, and rash.
Setting: Inpatient Rehabilitation hospital.
Patient: A 65-year-old man with small to medium vessel vasculitis.
Assessment/Results: Physical exam revealed distal limb weakness (0/5 to 1/5 at the wrist, hands, ankles, and feet), hyporeflexia, and severe allodynia. Diagnostic workup included MRI (which revealed only mild degenerative joint disease), EMG (severe multifocal motor and sensory axonal neuropathy in each limb), and initially positive anti-PR3 however was negative upon repeat testing. Temporal artery biopsy demonstrated small vessel vasculitis and lower extremity punch biopsy showed leukocytoclastic vasculitis. CK levels were over 3,000 and inflammatory markers were elevated. A diagnosis of small to medium vessel vasculitis was given, and hospital course was complicated by testicular infarction and severe pain. Patient underwent treatment with steroids, IVIG, cyclophosphamide infusion, and interdisciplinary rehabilitation (acute × 27 days, inpatient 43 days). Strength and functional improvement were made in areas of mobility (total assist to modified independent utilizing platform walker), transfers (max assist to contact guard assist), self-care (grooming from dependent to moderate assistance), and bladder (from incontinent to voluntary control).
Discussion: We present a case of functional quadriparesis due to vasculitic peripheral neuropathy. Resolution of the inflammatory process as well as intensive inpatient rehabilitation allowed for improvement of functional status.
Conclusion: The patient was initially denied insurance approval however this was overturned by highlighting family support to discharge home at the power wheelchair level. This case highlights a patient population that may benefit from interdisciplinary rehabilitation in order to improve functional outcome and reduce the risk of complications from prolonged immobility.
Level of Evidence: Level V
To cite this abstract in AMA style:Dena BM, Hupe J, Carter W. Patient with Vasculitic Peripheral Neuropathy Affecting Bilateral Upper and Lower Extremity Distal Limbs: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/patient-with-vasculitic-peripheral-neuropathy-affecting-bilateral-upper-and-lower-extremity-distal-limbs-a-case-report/. Accessed December 9, 2023.
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