927 - A Case Report of Seronegative Immune-Mediated Necrotizing Myositis in Acute Inpatient Rehabilitation

Seronegative Immune-Mediated Necrotizing Myositis

Case Description: A 43-year-old female with a history of PCOS, anxiety, and depression presented with progressive symmetric proximal weakness. Initial workup of laboratory tests and MRI yielded elevated CK and proximal muscle atrophy. Muscle biopsy with neuromuscular medicine was consistent with inflammatory necrotizing myopathy. Initially, she underwent IV steroids, IVIG, and Methotrexate with improvement. She was able to return home without requiring inpatient rehabilitation. Her course followed the recrudescence of symptoms requiring hospital admission for further IVIG and Rituxan infusions. This time, her response was not as robust as it initially was. She required inpatient rehabilitation where functional progress was halted, prompting another course of IVIG and Rituxan at rehab. She eventually reached partial assist at wheelchair level and was discharged home with a lift. At rehab, she was under co-management with neuromuscular medicine/neurology.

Discussions:

Prehabilitation has gained traction recently as more facilities incorporate the early adoption of rehabilitation medicine services in disease courses. Instead of relying on rehabilitation to regain what is lost, there is great value in preventing it. This case report effectively illustrates the two timelines of solo infusion therapy versus the early incorporation of rehabilitation medicine. This patient, unfortunately, had significant deficits in strength that limited her function prior to her introduction to acute inpatient rehabilitation; however, the progress she made during infusion therapy while also receiving inpatient rehab was subjectively and objectively greater.

Conclusions:

Patients can recover with medicinal therapies, but the power of simultaneous rehabilitation cannot be understated. We have seen the utilization of our field of medicine in cancer treatment, surgical pre-operation, and as an adjunct to chronic pharmacotherapies. This case highlights the impact that rehabilitation medicine can have on the world of neuromuscular disease processes. Early introduction and consistent utilization of PM&R services can be beneficial to this patient population.