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504 - A Unique Case of CIDP with Bowel Involvement

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Co-Author(s)

RM

Rebecca Martin, MD

Resident
Cincinnati Children's
Cincinnati, Ohio, United States
MK

Megan Kennelly, MD

Clincal Fellow
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States

Presenting Author(s)

Ashlee K. Bolger, MD (she/her/hers)

Associate Professor of Clinic Pediatrics and Neurology and Rehabilitation Medicine
Cincinnati Children's/ University of Cincinnati COM
Cincinnati, Ohio, United States

Case Diagnosis: Lower motor neuron bowel dysfunction during an active CIDP flare.

Case Description: A 20-year-old female with a history of type 1 diabetes and a recent diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP), admitted for worsening lower extremity weakness and recurrent falls. Diagnostic workup, including lumbar MRI, revealed new cauda equina nerve root enhancement at L1, L2, L5, and S2. The patient was treated with high-dose corticosteroids and intravenous immunoglobulin (IVIG) for presumed CIDP flare. She was subsequently transferred to acute inpatient rehabilitation. Therapy sessions were frequently disrupted by bowel incontinence, which persisted despite reducing stool softeners. Rectal examination showed intact sensation but absent voluntary anal contraction and absent resting rectal tone. The patient’s stool softeners were gradually discontinued, leading to some improvement in bowel control. Pelvic floor exercises were incorporated into physical therapy sessions for additional treatment of her absent rectal tone. By the time of discharge, the patient’s bowel incontinence had significantly improved and she was discharged without bowel medications.

Discussions: CIDP is an immune-mediated polyneuropathy marked by segmental demyelination of nerve roots and peripheral nerves presenting as a progressive or relapsing and remitting, peripheral symmetric limb weakness and sensory loss. CIDP typically affects the motor and sensory spinal nerves, sparing the cranial nerves, respiratory muscles, and autonomic nerves supplying the bowel and bladder. This case highlights a patient with demyelination in the cauda equina nerve roots with corresponding new-onset neurogenic bowel dysfunction during a CIDP flare, a presentation that is rarely reported in the literature.

Conclusions: While bowel dysfunction is not commonly associated with CIDP, this case demonstrates its possible occurrence during an active flare, with corresponding demyelinating changes on imaging. Awareness of this potential complication is important for physiatrists to ensure appropriate management.