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General Rehabilitation

(Kiosk 1) An Acute Presentation of Chronic Inflammatory Demyelinating Polyneuropathy: A Case Report

Friday, November 17, 2023
8:00 AM – 9:15 AM CT

    Primary Author(s)

  • Simron Gill, MD (he/him/his)

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    New york, New York

    • Co-Author(s)

  • Miriam Bekhit, MD, Other

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

  • Ryan Kim, DO

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Saddle Brook, New Jersey

  • GK

    Getahun Kifle, MD

    Attending Physician
    n/a
    Brooklyn, New York

  • SA

    Sanjeev Agarwal, MD

    Program Director
    SUNY Downstate Medical Center
    Brooklyn, New York

Case Diagnosis: 52-year-old male with chronic inflammatory demyelinating polyneuropathy (CIDP)

Case Description or Program Description: The patient is a 52-year-old male with panhypopituitarism secondary to resected pineal germ cell tumor who presented to the hospital with one week of progressive ascending lower extremity paresthesia, weakness, and gait dysfunction. He had a notable history of urinary tract infection one week prior to symptom onset. Lumbar puncture showed albuminocytological dissociation, suggestive of acute inflammatory demyelinating polyneuropathy (AIDP). He was given intravenous immunoglobulins (IVIg), and subsequently admitted to acute inpatient rehabilitation. During his admission, he showed minimal improvement in function and motor strength over four weeks. Physical exam was consistent for areflexia, decreased proprioception, and profound sensory loss to fine touch/vibration in bilateral lower extremities. Daily measurements of negative inspiratory forces (NIF) were started, along with increased hemodynamic monitoring. A rapid response was called due to respiratory deterioration requiring intubation and transfer to the ICU.

Setting: Inpatient rehabilitation facility

Assessment/Results: His hospitalization was prolonged for several months, with relapsing-remitting course, complicated by pneumonia, sodium derangement, and ventilator dependency. Additional treatment included two rounds of IVIg, plasma exchange, and intravenous hydrocortisone. Electrodiagnostic testing was deferred due to unstable patient status.

Discussion (relevance): Distinguishing between AIDP and CIDP can be difficult in the acute inpatient setting. Careful monitoring is needed in patients whose functional, neurological, and respiratory symptoms show minimal to no improvement after treatment with immunomodulatory therapy. CIDP is typically a progression or relapsing-remitting course of the disease lasting greater than eight weeks

Conclusions: It is important to be aware of symptoms progressing beyond the typical nadir of 4 weeks in AIDP, prompting investigation of a possible alternative diagnosis of other forms of polyneuropathy. Patients with immune mediated neuropathies should be monitored for any signs of deterioration while undergoing therapy in the acute inpatient rehabilitation setting.