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General Rehabilitation

Bridging Hormonal Therapy and Rehabilitation, a Novel Approach to Glucocorticoid-induced Myopathy: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 1

    Poster Presenter(s)

  • Tahreem Hashmi, DO

    Resident Physician PGY3
    Memorial Healthcare System (Hollywood) PM&R Program
    Cooper City, Florida

    • Co-Author(s)

  • TH

    Taha Hashmi, Other

    Student
    Florida International University
    Cooper City, Florida

  • Neenu Cherian, MD

    Attending Physician
    Memorial Healthcare System
    Hollywood, Florida

Disclosure(s):
Tahreem Hashmi, DO: No financial relationships to disclose
Neenu Cherian, MD: No financial relationships to disclose
Case Diagnosis: Glucocorticoid-induced myopathy in the setting of graft-versus-host disease

Case Description or Program Description: 64-year-old male with blastic plasmacytoid dendritic cell neoplasm underwent multiple lines of chemotherapy and bone marrow transplant complicated by graft-versus-host disease (GVHD) with frequent hospitalizations. He presented after falling due to leg weakness. He subsequently developed glucocorticoid (GC)-induced myopathy (GCM) from GVHD treatment and exogenous steroid use. He was placed on weekly 100 mg testosterone injections and admitted to acute inpatient rehabilitation.

Setting: Acute inpatient rehabilitation

Assessment/Results: After two weeks of rehabilitation with testosterone treatment, he progressed from maximum assistance to independence in activities of daily living (ADLs) and supervision for mobility. Initially, he walked 20 meters requiring frequent breaks and upper extremity reliance (moderate-max assist). By discharge, he walked 50 meters with supervision, needed fewer, shorter breaks, demonstrating endurance improvement.

Discussion (relevance): GCs induce muscle catabolism via proteolytic upregulation, myocyte apoptosis, and mitochondrial caspase activation. Quadriceps are most affected, causing proximal lower extremity weakness. GVHD treatment relies on high-dose GCs, increasing GCM risk leading to functional impairment, with less than 30% achieving independent functional independence measure (FIM) scores. Discontinuing GCs is primary treatment, while physical therapy improves strength.

Testosterone promotes muscle hypertrophy through erythropoiesis and protein synthesis. Combined with exercise, it enhances muscle mass, strength, and function in older men. GCs reduce circulating testosterone, contributing to GCM. Testosterone can mitigate GC-induced muscle atrophy, but its efficacy in GVHD-related GCM during acute rehabilitation requires further research. A multidisciplinary approach with oncology, physiatry, and therapy is essential as a potential discussion for treatment.

Conclusions: This case highlights testosterone as a potential adjunct therapy for GCM in GVHD, expediting recovery and improving functionality. It is a clinically indicated treatment and should be considered in the setting of GCM. The patient’s endurance for rehabilitation was crucial for ADL and mobility recovery, supporting further research into testosterone as a treatment option.