Bilateral Femoral Nerve Compression and Compartment Syndrome Resulting from Influenza A–Induced Rhabdomyolysis: A Case Report

Abstract

Bilateral femoral nerve compression neuropathy caused by primary iliopsoas muscle pathology is rare. We report a case of extensive compartment syndrome of the right arm and both legs associated with bilateral femoral nerve palsy resulting from severe muscle swelling secondary to influenza A infection. Our objective is to alert physicians to the possible development of compartment syndrome in patients with influenza and severe myalgia. We also reviewed the literature on the pathophysiology and management of femoral nerve compression neuropathy.

Myositis, rhabdomyolysis and compartment syndrome complicating influenza A in a child

“…After fasciotomies muscle swelling may continue, as there is primary muscle pathology. Extensive compartmental involvement can also be a feature of influenza associated myositis 4 , 5. The classic symptoms of severe muscle pains, weakness and urinary discoloration are not always present in children and may be difficult to elicit—for example, our patient had a reduced level of consciousness.…”

“…There are a few case reports of rhabdomyolysis, renal failure and compartment syndrome in adults, but numbers are small and not all cases were fatal 1 , 2 , 5. Viral myositis is uncommon in adults.…”

Bilateral Femoral Neuropathy: A Rare Complication of Drug Overdose due to Prolonged Posturing in Lithotomy Position

“…(a) Stretching and/or prolonged compression of the nerve caused by the self-retaining retractors that can directly compress the nerve against the pelvic sidewall (b) Compression of the iliac vessels causing direct ischemia of the nerve (c) Prolonged compression of the femoral nerves under the inguinal ligament, or (d) Excessive stretching due to excessive abduction and external rotation of the hips during lithotomy positioning [2][3][4][5][6] In addition to the above iatrogenic causes, there are reports of rare cases of bilateral femoral nerve compression and ischemia due to iliopsoas hematomas [7][8][9][10] and iliopsoas swelling secondary to rhabdomyolysis [11,12]. ere are also individual reports of bilateral femoral neuropathy due to vasculitis in the context of disseminated intravascular coagulopathy [13] and due to blunt force trauma [14].…”

Three-limb compartment syndrome and rhabdomyolysis after robotic cystoprostatectomy

“…Without emergent decompressive fasciotomy of the affected extremity, long-term neuromuscular deficits or loss of limb may result. Whether WLCS precedes the rhabdomyolysis, or vice versa, is unclear [2,3], though most authors report clear improvement in rhabdomyolysis once compartment syndrome is diagnosed and treated. There are multiple known risks for the development of compartment syndrome, and a case of threelimb involvement following robot-assisted laparoscopic cystoprostatectomy is presented.…”