861 - POEMS syndrome: An inpatient rehabilitation perspective

POEMS (polyneuropathy, organomegaly, endocrinopathy, myeloma protein, skin changes) syndrome 

Sensorimotor polyneuropathy with axonal loss 


Case Description: A 49yo man with hypertension presented to the hospital with subacute balance impairment, feet numbness, and distal weakness in all extremities initially charted to vitamin B12 deficiency. During admission, he was diagnosed with an acquired demyelinating, sensorimotor polyneuropathy with secondary axonal loss, treated with IVIG for presumed CIDP, and discharged to IRF. At IRF, there was no neurologic improvement although he developed new chest pain. After investigation, a pleural effusion and T11 mottled sclerosis revealed themselves. Further workup by Neuromuscular Medicine and Hematology/Oncology diagnosed him with POEMS syndrome. His POEMS treatment plan was outpatient follow-up for prior authorization and chemotherapy initiation. Considering the importance of early treatment, IRF focused on patient/caregiver training, equipment assessment, bracing needs, and transportation problem-solving for a safe but sooner discharge. His IRF admission also included a second course of IVIG and aspirin for thrombocytosis. He was discharged with a power wheelchair and outpatient day program. 

Discussions: POEMS syndrome is a complex disease that physiatrists should be aware of when forming a differential diagnosis in patients with polyneuropathy. POEMS syndrome poses unique challenges ranging from the loss of function from polyneuropathy to navigating treatment plans. The weakness from polyneuropathy was particularly distressing for the patient and can be progressive without treatment. Once POEMS syndrome has been elucidated, consultation with Neuromuscular Medicine and Hematology/Oncology would help the patient and inform the discharge planning process.  

Conclusions: POEMS syndrome management needs the entire breadth of interdisciplinary care not just at the IRF but also afterward. Close coordination with Neuromuscular Medicine and Hematology/Oncology helps ensure treatment is not delayed while also considering what outpatient therapies will entail.