1225 - Improved Function in a Patient with Autoimmune Cervicothoracic Myelopathy after IVIG Therapy & Rehabilitation

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

JP

Joann Pan, BA

Ms.
Baylor College of Medicine
Houston, Texas, United States
TL

Ton La, Jr., MD, JD

Resident Physician
Baylor College of Medicine
Houston, Texas, United States

Co-Author(s)

IH

Ishaan Hublikar, DO

Dr.
UTHealth Houston McGovern Medical School
Houston, Texas, United States
Joel E. Frontera, MD

Associate Professor and Vice Chair for Education
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Nikola Dragojlovic, DO (he/him/his)

Assistant Professor, Residency Program Director
University of Texas Heath Science Center at Houston, TIRR Memorial Hermann
Houston, Texas, United States

Case Diagnosis: Autoimmune myelopathies can cause loss of muscle strength, and additional neurological deficits.1. We present a case of markedly improved strength and function after multiple rounds of intravenous immunoglobulin (IVIG) therapy, inpatient therapy, and outpatient therapy, in our patient with autoimmune cervicothoracic myelopathy that was also COVID-19 (SARS-CoV2)-induced. Reference:Lopez Chiriboga S, Flanagan EP. Myelitis and Other Autoimmune Myelopathies. Continuum. 2021 Feb 1;27(1):62-92

Case Description: A 29-year-old female with a history of scoliosis, presented with 10 days of rapidly progressive leg weakness. During her stay, she developed ascending upper extremity weakness and urinary retention and imaging showed signs of myelopathy. She underwent 3 rounds of IVIG and steroids, with slight hand strength improvement. She was admitted to inpatient rehabilitation with paraparesis, muscle spasms, pain, numbness, and impaired mobility. Lower extremity strength was 0/5 but upper extremity strength remained intact. During her stay, she went through intensive inpatient therapy. She was discharged on medications for spasticity and pain and continued on oral steroids. Notably, afterwards, she continued receiving additional IVIG rounds and also outpatient rehabilitation.

Discussions: At follow-up 13 months after initial presentation, the patient had significantly improved hip flexion (0 to 4) and knee extension (0 to 5) strength. She regained full lower extremity range of motion and improved dorsiflexion/plantarflexion strength from 0 to 2. She could stand without assistance and use a standing walker independently in physical therapy. She also had notable improvement in hygiene, dressing, and footwear management.

Conclusions: This case demonstrates a patient with autoimmune cervicothoracic myelopathy with substantially improved strength and function after IVIG therapy and rehabilitation therapies 13 months later. Additional studies are warranted to establish more information on guidelines for IVIG and rehabilitation management for COVID-19 (SARS-CoV2)-induced myelopathy. For transparency, it should be noted that a version of this case study has previously been submitted to ASIA