Rhabdomyolysis with Acute Kidney Injury Caused by Bilateral Iliopsoas Hematoma in a Patient with Atrial Fibrillation

Watanabe, Yûsuke; Koutoku, Honoka; Nagata, Hiroyuki; Oda, Yuya; Kikuchi, Hitoshi; Kojima, Masayasu

doi:10.2169/internalmedicine.2749-19

Cited by 4 publications

(4 citation statements)

References 13 publications

(16 reference statements)

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“…There are also other reports in the literature concerning idiopathic IPH in anticoagulated patients even if not affected by COVID-19: Apostolopoulos et al 17 described a man treated with warfarin who developed extensive IPH with femoral nerve palsy. A similar case is reported by Watanabe et al 18 where a patient, also on warfarin treatment, developed a rhabdomyolysis caused by bilateral IPH. Risch et al 19 described five cases of non-traumatic IPH in patients treated with an anticoagulant.…”

Section: Discussionsupporting

confidence: 79%

Iliopsoas hematoma in patients with COVID-19 on low-molecular-weight heparin treatment

Sottilotta¹,

Mangano

Basile

et al. 2021

SAGE Open Medical Case Reports

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Patients with COVID-19 are at high risk of thromboembolic events; for this reason, the use of heparin is largely recommended but, in addition to thrombotic complications, bleeding is a significant cause of morbidity in patients with COVID-19. Idiopathic iliopsoas hematoma is a very rarely described hemorrhagic complication in patients with COVID-19. We report here two cases of iliopsoas hematoma in male patients with COVID-19 and being treated with heparin.

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Section: Discussionsupporting

confidence: 79%

Iliopsoas hematoma in patients with COVID-19 on low-molecular-weight heparin treatment

Sottilotta¹,

Mangano

Basile

et al. 2021

SAGE Open Medical Case Reports

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“…Coagulation disorders (warfarin [13,18] , heparin [5,15] , and edoxaban use); 2: Hemophilia [7,10] ; 3: Traumatic injury [2] (e.g., sports injuries, falls, high-impact trauma, and car accidents); 4: Other causes [10,12,19,20] (including spontaneous bleeding due to Mediterranean anemia [21] , cirrhosis [17] , and splenomegaly-related bleeding [21] )…”

Section: Discussionmentioning

confidence: 99%

“…For example, patients with coagulation disorders regularly exhibit no apparent triggers or experience mild falls before the onset of lower back or hip pain [12] . However, in severe cases of this hematoma, lower limb neurological impairment, organ dysfunction, and even death can occur [5,13] . Such patients and the primary attending medical personnel commonly overlook these symptoms initially, misidentifying them as lumbar strains or similar injuries.…”

Section: Introductionmentioning

confidence: 99%

Clinical Case Analysis of Iliopsoas Hematoma Causing with Femoral Nerve Compression

Li,

Peng,

Gong

et al. 2023

Preprint

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Background: To investigate the clinical manifestation and prognosis of iliopsoas hematoma (IPH) associated with femoral nerve compression and enhance the current understanding of IPH. Methods: Patients diagnosed with IPH from March 2014 to January 2023 at the Affiliated Hospital of Southwest Medical University were assessed. The main clinical indicator observed was visual analog scale (VAS) score before treatment as well as at 1 week and 1, 3, and 6 months after treatment. Secondary indicators included the degree of lower limb numbness before and after treatment, muscle strength, hip flexion degree, the distribution of affected nerves, hematoma size, and hematoma distribution. Results: A total of 28 patients were included, among which 24 were men, and the average age (median [interquartile range]) was 48 (20.25, 63) years. The average duration of disease onset was 3 (1.25, 7) days, and 16 patients (57.14%) exhibited coagulation dysfunction. After 1 week of treatment, a 50% reduction in the VAS score was noted in 18 patients (64.28%). Furthermore, VAS score at 1 week and 1, 3, and 6 months after treatment were significantly lower than the baseline VAS score (P < 0.05). Baseline lower limb sensation was grade I in two patients, followed by grades II, III, and IV in five, 11, and 10 patients, respectively. After 6 months, 22 patients (78.57%) recovered to grade I. Baseline muscle strength of the lower limb was grade II in one patient, while grades III, IV, and V were in 10, eight, and nine patients, respectively. After 6 months, 19 patients (67.85%) exhibited improvement to grade V. The baseline degree of hip flexion was graded I and II in 53.57% of the patients, with enhancement to grade III after 6 months in 25 (89.28%). Hematoma distribution was localized in the mid-zone in 21% of the patients; upper-mid zone, 29%; mid-lower zone, 29%; and upper-mid-lower zone, 21%. In terms of affected nerves, femoral nerve involvement was revealed in 25 patients (89.28%), whereas lateral femoral cutaneous nerve involvement in 15 (53.57%). Conclusions: IPH is mainly caused by coagulation dysfunction and is often accompanied by pain and femoral nerve involvement that result in slow neurological recovery. Furthermore, the timely detection and causal treatment of IPH may help achieve a favorable prognosis.

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“…Artzner et al [ 9 ] conducted a two-center retrospective study to analyze the incidence of spontaneous iliopsoas muscle hematoma among 40 ICU inpatients, of whom 50% received dialysis and 95% received prophylactic or therapeutic doses of heparin. Watanabe et al [ 10 ] reported a patient treated with warfarin for atrial fibrillation complicated with bilateral lumboiliac hematoma, rhabdomyolysis, and acute kidney injury, which was attributed to improper use of warfarin. The two cases reported here were both heat stroke patients who had rhabdomyolysis and acute kidney injury and were treated with heparin-based CRRT.…”

Section: Discussionmentioning

confidence: 99%

Intramuscular hematoma in rhabdomyolysis patients treated with low-molecular-weight heparin: Report of two cases

Yuan

Xie

Yang

2021

WJCC

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BACKGROUND Rhabdomyolysis is a serious complication of heat stroke. Unlike that in acute kidney injury, the risk of muscle bleeding in rhabdomyolysis is often ignored and can substantially increase via the widespread use of anticoagulants, leading to the formation of intramuscular hematoma. CASE SUMMARY During the summer, a middle-aged man and an elderly man were diagnosed with heat stroke, rhabdomyolysis, and acute renal impairment. Low-dose enoxaparin sodium was initiated for prophylaxis of deep vein thrombosis after the disease was stabilized with continuous renal replacement therapy. After that, the patients' hemoglobin decreased progressively, and no obvious intracranial, thoracic, digestive, or skin bleeding tendency was found. However, one of the patients had hip muscle pain, and computed tomography and color ultrasound confirmed that the patients separately had lumbar back and hip intermuscular hematoma. After discontinuation of anticoagulant drugs and monitoring of the steady increase in hemoglobin, the intermuscular hematomas were gradually absorbed. Following the use of prophylactic anticoagulation therapy, the patients' hemoglobin showed a progressive downward trend. Hematoma formation in the lumbosacral and buttock muscles was confirmed after excluding bleeding in typical regions (such as the digestive tract, thoracic cavity, and abdominal cavity). Anticoagulant drugs were discontinued immediately, and nutritional support was increased. Subsequently, the hemoglobin levels gradually increased, and the hematoma volumes gradually decreased. CONCLUSION Patients with rhabdomyolysis have a risk of muscle bleeding, and inappropriate use of anticoagulants may lead to an increased risk or even to the formation of an intermuscular hematoma. When continuous blood loss is found in the body, the possibility of bleeding in the muscles and more typical sites should be considered.

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Rhabdomyolysis with Acute Kidney Injury Caused by Bilateral Iliopsoas Hematoma in a Patient with Atrial Fibrillation

Cited by 4 publications

References 13 publications

Iliopsoas hematoma in patients with COVID-19 on low-molecular-weight heparin treatment

Iliopsoas hematoma in patients with COVID-19 on low-molecular-weight heparin treatment

Clinical Case Analysis of Iliopsoas Hematoma Causing with Femoral Nerve Compression

Intramuscular hematoma in rhabdomyolysis patients treated with low-molecular-weight heparin: Report of two cases

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