205 - An Interdisciplinary Approach for Diagnosing and Managing POEMS Syndrome During Inpatient Rehabilitation: A Case Report

Case Diagnosis: A 56-year-old female with adrenal insufficiency, hypothyroidism, and restrictive lung disease status-post lung transplantation was diagnosed with POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder, Skin changes) Syndrome.

Case Description: The patient presented to acute care with bilateral lower-extremity areflexia, hypoesthesia, and weakness. Electromyography demonstrated severe, length-dependent, symmetrical sensorimotor polyneuropathy with demyelinating features. She received one loading dose of IVIG. Workup revealed a sclerotic C2 lesion and IgG-lambda monoclonal gammopathy, but no definitive diagnosis was established.
In inpatient rehabilitation, she was non-ambulatory with diffuse 0/5 leg strength and ADLs required at least maximal assistance. A maintenance IVIG dose was administered, and endocrinopathies were managed. Results from bone marrow and fat pad biopsies revealed mild plasmacytosis (2%) and eliminated amyloidosis and multiple myeloma as differential diagnoses. Vascular endothelial growth factor, a key POEMS marker, was elevated at 170 pg/mL.
She achieved modest proximal leg strength (< antigravity) and developed neuropathic pain. Functionally, she progressed to adaptive wheelchair level, improved bed mobility, and completed caregiver training. Upon return to acute care, given anasarca, pleural effusions, and papilledema, a formal diagnosis was made. 

Discussions:

POEMS syndrome is a rare multisystem paraneoplastic condition that is infrequently encountered in inpatient rehabilitation and requires coordinated, multi-specialty care. In this case, diagnosis and management involved specialists in hematology, neurology, endocrinology, and physiatry. Its presentation can overlap with chronic inflammatory demyelinating polyradiculoneuropathy, monoclonal gammopathy of undetermined significance, and amyloidosis.

Conclusions: This case highlights the importance of inpatient rehabilitation in facilitating interdisciplinary collaboration during both diagnostic workups and management for patients with complex neurological disorders.