SHM Converge Scientific Abstract ePoster Gallery-Delayed Diagnosis of Brachial Plexopathy After Stem Cell Transplantation

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Brachial plexopathy, also called Parsonage-Turner syndrome (PTS), is a rare neurological disorder that typically presents with sudden, severe shoulder pain. It is uncommon in the general population, with an estimated incidence of 2 to 3 cases per 100,000 people per year, and most cases are unilateral.<br /><br />This report describes a 70-year-old woman with multiple myeloma who developed bilateral sharp shoulder pain 8 days after an autologous stem cell transplant. Because of the timing and severity of symptoms, imaging was obtained. PET/CT showed increased uptake along the infraspinatus muscles, and MRI of the brachial plexus demonstrated increased hyperintense signal involving the roots, trunks, and divisions of the brachial plexus. Based on the clinical presentation and radiologic findings, she was diagnosed with PTS.<br /><br />The exact cause of PTS is not fully understood, but it is thought to involve a combination of genetic susceptibility and acute immune triggers that lead to nerve inflammation. Imaging may show hourglass constrictions in affected nerves, and nerve biopsy can reveal multifocal inflammatory infiltrates.<br /><br />There are no established treatment guidelines. Therapies used in practice include corticosteroids, IVIG, and plasmapheresis; surgery is reserved for severe or refractory cases. This patient was treated with high-dose intravenous methylprednisolone and IVIG for 3 days, leading to improvement in pain. Her course was mainly pain-predominant, with continued improvement at 3 months and complete pain resolution by 7 months.<br /><br />This case highlights that PTS can occur within the first 1 to 2 weeks after autologous hematopoietic stem cell transplantation and should be considered when patients develop acute shoulder pain after transplant.

Asset Subtitle

Zhanna Albany

Meta Tag

Author List Areeba Kara, Shums Parkar, Tabassum Parkar, Umber Shafique, Zhanna Albany

Category Clinical Vignettes

Concept Parsonage-Turner Syndrome

Concept Acute Shoulder Pain

Concept Autologous Stem Cell Transplantation

Concept Brachial Plexus

Concept Hour-Glass Constriction

Distinguished Non-Finalist

Presenter Organization Indiana University School of Medicine

Presenting Author Zhanna Albany

Track Adult

Keywords

Brachial plexopathy

Parsonage-Turner syndrome

Shoulder pain

Multiple myeloma

Autologous stem cell transplant

Bilateral symptoms

PET/CT imaging

MRI brachial plexus

Corticosteroid therapy

IVIG treatment

Parsonage-Turner Syndrome

Acute Shoulder Pain

Autologous Stem Cell Transplantation

Brachial Plexus

Hour-Glass Constriction