Challenging differential diagnosis, Management of emergency care, Rare disease
Muhammad Adrish, Richard Duncalf, Gilda Diaz-Fuentes, Sindhaghatta Venkatram
Division of Pulmonary and Critical Care Medicine, Albert Einstein College of Medicine, Bronx Lebanon Hospital Center, Bronx, USA
Am J Case Rep 2014; 15:22-26
Available online: 2014-01-15
Background: Heroin addiction is common, with an estimated 3.7 million Americans reporting to have used it at some point in their lives. Complications of opiate overdose include infection, rhabdomyolysis, respiratory depression and central or peripheral nervous system neurological complications.
Case Report: We present a 42-year-old male admitted after heroin use with heroin-related peripheral nervous system complication preceded by an acute gluteal compartment syndrome and severe rhabdomyolysis.
Conclusions: Early diagnosis and surgical intervention of the compartment syndrome can lead to full recovery while any delay in management can be devastating and can lead to permanent disability. The presence of peripheral nervous system injuries may portend a poor prognosis and can also lead to long term disability. Careful neurological evaluation for signs and symptoms of peripheral nervous system injuries is of paramount importance, as these may be absent at presentation in patients with opioid overdose. There is a potential risk of delaying a necessary treatment like fasciotomy in these patients by falsely attributing clinical symptoms to a preexisting neuropathy. Early EMG and nerve conduction studies should be considered when the etiology of underlying neurological weakness is unclear.
Keywords: Addiction, Heroin, rhabdomyolysis, Peripheral Nervous System, Disorder, Opioid-Related, electromyography