529 - Challenges of rehabilitation in Multiple Myeloma with prophylactic intramedullary nailing of bilateral upper and lower extremities: A Case Report

Case Diagnosis: Multiple Myeloma

Case Description: Multiple Myeloma(MM) is a complex disease often characterized by lytic bone lesions requiring surgical intervention. We present the case of a 46-year-old male with history of diabetes who presented with left shoulder and low back pain for a year. Imaging revealed compression fracture of L2 with spinal canal stenosis and lytic lesions in the left shoulder. Skeletal survey revealed extensive lytic lesions throughout the axial and appendicular skeleton. Initial laboratory findings showed anemia, hypercalcemia, and an elevated globulin/albumin ratio, with serum immunofixation indicating elevated IgG and an M-spike. Bone marrow biopsy confirmed the diagnosis of MM. The spinal compression fracture was managed conservatively with a TLSO and decadron taper. Given high risk of pathological fractures (Mirel's score of 10), patient underwent prophylactic internal fixation of bilateral femurs and humeri in two-stages over three days. He was started on radiation therapy for his lumbar spine before admission to acute rehabilitation unit.

Discussions: This atypical presentation of MM posed unique challenges during acute rehabilitation. These challenges encompassed optimizing pain management, closely monitoring anemia and blood loss, regulating blood glucose levels during steroid therapy, and addressing fatigue, mood disturbances, and sleep disruptions resulting from radiation therapy. These debilitating complications can significantly impact patients' quality of life and hinder functional recovery.

Conclusions: Patients with extensive bony involvement due to MM in the acute rehabilitation setting necessitate a comprehensive approach. Clinicians who are aware of these potential challenges are better equipped to provide care for MM patients and enhance their functional outcomes.