207 - Inpatient Rehabilitation for CIDP Exacerbation: Integrating IVIG with Active Therapy

The patient presented to the ED with ascending lower extremity weakness. He was diagnosed with a CIDP flare and received intravenous immunoglobulin (IVIG) treatment in the acute care setting, resulting in initial improvement. He was transferred to inpatient rehabilitation and showed early gains in strength and mobility. 

On day 10, he developed worsening lower extremity and hand weakness with proximal pain. Neurology recommended urgent IVIG re-initiation given his risk for further functional decline. He received nightly IVIG 400 mg/kg for 5 days while continuing daily therapies as tolerated. Rehabilitation goals were adapted to focus on bed mobility, wheelchair skills, seated balance, and upper extremity strengthening, deferring pre-gait training until stabilization.

Despite these challenges, he demonstrated functional gains: bed mobility and transfers improved from maximal to moderate assistance, wheelchair mobility advanced to modified independent on level surfaces, and upper-body dressing and oral hygiene progressed to setup or independent.

Discussions: To our knowledge, this is the first reported case of a patient with CIDP receiving a full course of IVIG during an inpatient rehabilitation stay while continuing active therapy. This approach allowed the patient to receive urgent immunomodulatory treatment without interrupting his rehabilitation. The case underscores the importance of close interdisciplinary communication in identifying and responding to disease flares, and the importance of flexible therapy planning to maintain functional progress.

Conclusions: CIDP exacerbations can occur during rehabilitation and require immediate intervention. This case exemplifies how delivering IVIG in the rehab setting while continuing modified therapies may preserve functional gains and reduce disruption to the recovery process.