G Model BONSOI-4020; No. of Pages 1
ARTICLE IN PRESS Joint Bone Spine xxx (2014) xxx–xxx
Available online at www.sciencedirect.com
Images in rheumatology
An atypical sciatica revealing a rhabdomyolysis Aurélie Croci-Torti a , Yann Thouvenin b , Pierre Le Blay a , Yves-Marie Pers a,∗ a b
Clinical immunology and osteoarticular diseases therapeutic Unit, Lapeyronie University Hospital, 371, avenue du doyen-Gaston-Giraud, 34295 Montpellier, France Department of Radiology, Lapeyronie Hospital, 34295 Montpellier, France
Fig. 1.
A 50-year-old female was admitted to the emergency department after a prolonged immobilization. She denied any alcohol or drug abuse. She presented a left sciatic and severe motor nerve deficit on the triceps surae and fibularis muscles. Laboratory tests revealed high lactate dehydrogenase and creatinine phosphokinase levels. Leg MRI findings on T1 weighted sequence (Fig. 1A) showed an enlarged left sciatic nerve compared to the right side (arrows), surrounded by oedema with intra- and peri-neural infiltration. Fat saturated post-gadolinium T1 weighted sequence (Fig. 1B) showed a muscle infiltration, with a central enhancement defect of the adductor brevis, biceps femoris long head and semi-tendinosus (wide arrowheads), indicating muscular ischemia. Peri- and intraneural enhancement and soft tissue infiltration are also highlighted compared to the right side (arrows). Oral steroids were initiated at
1 mg/kg/day, leading to a clinical improvement and full normalization of muscle enzymes rates. Sciatic palsy and rhabdomyolysis have been already described for the gluteal compartment syndrome but never after thigh compression [1]. MRI is the method of choice to detect localizations of affected muscle, to detect early or late complications, and to follow radiological evolution [2]. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References
∗ Corresponding author. Tel.: +33 4 67 33 72 31; fax: +33 4 67 33 72 27. E-mail address: [email protected] (Y.-M. Pers).
[1] Prynn WL, Kates DE, Pollack Jr CV. Gluteal compartment syndrome. Ann Emerg Med 1994;24:1180–3. [2] Moratalla MB, Braun P, Fornas GM. Importance of MRI in the diagnosis and treatment of rhabdomyolysis. Eur J Radiol 2008;65:311–5.
doi:10.1016/j.jbspin.2014.03.018 1297-319X/© 2014 Société franc¸aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Croci-Torti A, et al. An atypical sciatica revealing a rhabdomyolysis. Joint Bone Spine (2014), doi:10.1016/j.jbspin.2014.03.018
ARTICLE IN PRESS Joint Bone Spine xxx (2014) xxx–xxx
Available online at www.sciencedirect.com
Images in rheumatology
An atypical sciatica revealing a rhabdomyolysis Aurélie Croci-Torti a , Yann Thouvenin b , Pierre Le Blay a , Yves-Marie Pers a,∗ a b
Clinical immunology and osteoarticular diseases therapeutic Unit, Lapeyronie University Hospital, 371, avenue du doyen-Gaston-Giraud, 34295 Montpellier, France Department of Radiology, Lapeyronie Hospital, 34295 Montpellier, France
Fig. 1.
A 50-year-old female was admitted to the emergency department after a prolonged immobilization. She denied any alcohol or drug abuse. She presented a left sciatic and severe motor nerve deficit on the triceps surae and fibularis muscles. Laboratory tests revealed high lactate dehydrogenase and creatinine phosphokinase levels. Leg MRI findings on T1 weighted sequence (Fig. 1A) showed an enlarged left sciatic nerve compared to the right side (arrows), surrounded by oedema with intra- and peri-neural infiltration. Fat saturated post-gadolinium T1 weighted sequence (Fig. 1B) showed a muscle infiltration, with a central enhancement defect of the adductor brevis, biceps femoris long head and semi-tendinosus (wide arrowheads), indicating muscular ischemia. Peri- and intraneural enhancement and soft tissue infiltration are also highlighted compared to the right side (arrows). Oral steroids were initiated at
1 mg/kg/day, leading to a clinical improvement and full normalization of muscle enzymes rates. Sciatic palsy and rhabdomyolysis have been already described for the gluteal compartment syndrome but never after thigh compression [1]. MRI is the method of choice to detect localizations of affected muscle, to detect early or late complications, and to follow radiological evolution [2]. Disclosure of interest The authors declare that they have no conflicts of interest concerning this article. References
∗ Corresponding author. Tel.: +33 4 67 33 72 31; fax: +33 4 67 33 72 27. E-mail address: [email protected] (Y.-M. Pers).
[1] Prynn WL, Kates DE, Pollack Jr CV. Gluteal compartment syndrome. Ann Emerg Med 1994;24:1180–3. [2] Moratalla MB, Braun P, Fornas GM. Importance of MRI in the diagnosis and treatment of rhabdomyolysis. Eur J Radiol 2008;65:311–5.
doi:10.1016/j.jbspin.2014.03.018 1297-319X/© 2014 Société franc¸aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Croci-Torti A, et al. An atypical sciatica revealing a rhabdomyolysis. Joint Bone Spine (2014), doi:10.1016/j.jbspin.2014.03.018
![[Sciatica revealing peri-neural cyst of the sacral bone].](/assets/img/hold.png)
