Prioritizing Mobilization with Multicentric Castleman’s Disease Superimposed on Incomplete Spinal Cord Injury: A Case Report

Research Objectives: To describe mobility progression of a patient with novel diagnosis of Idiopathic Multicentric Castleman’s Disease (iMCD) with lytic bone lesions and co-morbid incomplete spinal cord injury while on a general inpatient rehab unit.

Design: iMCD is a rare disorder that involves an overgrowth of cells in multiple lymph nodes. Incomplete spinal cord injury at the L1 level affects motor, sensory, proprioceptive input at and below the nerve root level. 19.6% of all spinal cord injury result in incomplete paraplegia. Limited evidence is published to guide physical rehabilitation treatment for iMCD.

Setting: 34 bed Inpatient Rehabilitation Unit within a 746-bed university affiliated tertiary hospital.

Participants: 31-year-old male with L1 AIS C spinal cord injury in 2019 and development of iMCD November 2022 with joint contractures and confined to his bed prior to inpatient rehabilitation unit admission.

Interventions: Physical and occupational therapy sessions, totaling 15 hours per week within a 27-day inpatient rehabilitation admission with clinical guidance from advanced practice clinicians. Interventions included progression for sitting and out of bed tolerance, static progressive splinting, motivational interviewing, self-management, and goal directed treatment planning.

Main Outcome Measures: GG Mobility and GG Self Care sections of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) 4.0, goniometry, manual muscle strength, number of therapy sessions and tolerance to sitting

Results: Physical and occupational therapists collected data in the inpatient rehabilitation setting related to progression of mobility, sitting tolerance, and joint range of motion. The patient had an IRF-PAI GG change of 28 points in a 27-day length of stay. Tolerance to sitting improved from dependent with assist of two clinicians to modified independent for 4 hours. Utilization of dynamic splinting for low load prolonged stretch for bilateral knee extension resulted in improvements of 10-12 degrees of extension.

Conclusions: Further investigation into the relationship between neurological rehabilitation principles and the clinical presentation of iMCD with lytic bone lesions and inflammatory arthritis is needed.

Author(s) Disclosures: No disclosures