593 - Inpatient Rehabilitation Outcomes Following A Rare Presentation of POEMS Syndrome: A Case Report

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

SH

Syed R. Husain, DO

Resident Physician
Rutgers NJMS/Kessler Institute for Rehabilitation
Morganville, New Jersey, United States

Co-Author(s)

SH

Sharon Hsu, MD

Resident Physician
Rutgers NJMS/Kessler Institute for Rehabilitation
West Orange, New Jersey, United States

Corresponding Author(s)

JN

Jeremiah D. Nieves, MD

Attending Physician
Rutgers NJMS/Kessler Institute for Rehabilitation
West Orange, New Jersey, United States

Case Diagnosis: 45-year-old male admitted for acute inpatient rehabilitation following severe gait and ADL dysfunction due to polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes (POEMS) syndrome - a rare paraneoplastic manifestation of plasma cell disorder with an estimated prevalence of only 0.3 per 100,000 people.

Case Description: Initial diagnosis of the plasma cell disorder occurred 9 months prior to presentation, during hospitalization for pericardial effusion when CTPE revealed an incidental sclerotic lesion at T4 prompting further evaluation. Subsequent testing revealed lambda restricted plasma cell disorder with marrow involvement. Initial treatment consisted of steroids and chemotherapy. Approximately 5 months following initial treatment, the patient began experiencing new lower extremity motor deficits that progressed significantly over a 4-month period. During a re-hospitalization due to hypotension and syncope, MRI demonstrated thickening and contrast enhancement of the nerve roots through the cauda equina. Nerve conduction studies demonstrated axonal demyelination. This severe polyneuropathy, together with history of plasma cell disorder, sclerotic bone lesion, and effusion, in addition to elevations in serum/plasma VEGF, met qualifying criteria for a diagnosis of POEMS syndrome. After further chemotherapy and stem cell transplantation, the patient was discharged to inpatient rehabilitation to address his functional deficits.

Discussions: Prior to onset of symptoms, the patient was functionally independent and employed full-time in law enforcement. On admission, ADL assistance varied from moderate-to-total assistance and motor deficits had progressed to include the bilateral distal upper extremities. Following three weeks of inpatient rehabilitation, the patient achieved improvements in functional status, including ADLs, bed mobility, lateral transfers, upright tolerance, and wheelchair propulsion.

Conclusions: POEMS syndrome is an extremely rare paraneoplastic syndrome due to underlying monoclonal plasma cell disorder that can lead to significant debility. This case underscores the critical role that physiatrists and comprehensive therapy programs play in improving deficits associated with POEMS and a patient’s function and quality of life.