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Final Program

517 - CIDP During Pregnancy: A Multidisciplinary Approach

Friday, February 28, 2025
5:00 PM - 6:30 PM MST

    Co-Author(s)

  • TP

    Tram J. Pham, DO

    PGY-4 Resident in PM&R
    University of New Mexico
    Albuquerque, New Mexico, United States

  • ZB

    Zackery Billington, DO

    Assistant Professor
    University of New Mexico
    Albuquerque, New Mexico, United States

  • TD

    Tyler Downs, n/a

    OMS4
    Rocky Vista COM
    Eagle Mountain, Utah, United States

Case Diagnosis: Chronic inflammatory demyelinating polyneuropathy 

Case Description: A 21-year-old woman at 19 weeks pregnant presents with progressive weakness and numbness, diagnosed as inflammatory demyelinating polyneuropathy. Her symptoms began in her facial muscles and worsened after an upper respiratory illness. She received 7 cycles of plasmapheresis and while undergoing IVIG, she developed a pulmonary embolism and HELLP syndrome, leading to an emergency C-section. She was also treated with dexamethasone with concern for chronic inflammatory demyelinating polyneuropathy. PM&R was consulted for neuropathic pain for which she was started on multiple neuropathic agents. After a temporary improvement, on the last day at IPR she experienced a relapse with visual disturbances, respiratory weakness, and altered mental status. Her second hospitalization was complicated by a lumbar drain infection and intracranial hypertension with associated papilledema. She was eventually discharged with improved arm strength but ongoing leg weakness.

Discussions:

Chronic inflammatory demyelinating polyneuropathy (CIDP) affects peripheral nerves and nerve roots. It typically causes symmetrical weakness in the proximal and distal muscles with sensory impairment. It often has an indistinct onset and can be progressive or follow a relapsing-remitting pattern. Similarly, acute inflammatory demyelinating polyneuropathy (AIDP) causes bilateral, symmetrical weakness, but it presents with an acute onset and follows a monophasic course. First-line treatment for CIDP includes IVIG, corticosteroids, and plasma exchange. Common complications of CIDP include respiratory failure, autonomic dysfunction, DVT, and PE. Due to the breadth of possible complications, it is important for patients to be followed by a multidisciplinary team, including a neurologist, intensivist, and physiatrist. In the presented case, it was imperative to have an obstetrician involved due to physiologic changes during pregnancy and to minimize risk to the fetus.

Conclusions: This is an atypical case of CIDP during pregnancy with multiple complications. This case highlights how CIDP and its complicated sequela are best managed by a multidisciplinary approach.