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可卡因诱发的急性肢体骨筋膜室综合征:一例罕见病例报告

Cocaine-Induced Acute Extremity Compartment Syndrome: A Rare Case Report.

作者信息

Al-Maharmeh Qusai, Haddad Ahmad W, Abouzeid Wassim, Kloub Mohammad, Haddad Deema

机构信息

Internal Medicine, Saint Michael's Medical Center, Newark, USA.

Internal medicine, Saint Michael's Medical Center, Newark, USA.

出版信息

Cureus. 2024 Mar 30;16(3):e57297. doi: 10.7759/cureus.57297. eCollection 2024 Mar.

Abstract

There is a dearth of research connecting acute extremities compartment syndrome to cocaine. Here, we present a case of a forty-year-old guy who is actively using cocaine and comes to the emergency room with excruciating right leg pain and swelling. Physical examination revealed substantial tachycardia, lack of dorsalis pedis pulses, stiff and painful calf muscles, and absence of plantar reflexes in the right lower extremities after sleeping on his right leg. A positive urine drug screen for cocaine, severe rhabdomyolysis, and acute renal damage warranted further laboratory testing. A diagnosis of compartment syndrome was established based on the lack of dorsalis pedis pulses in the right lower extremity and radiographic evidence of oedematous alterations in the calf muscles with perimuscular edema. For this case, acute renal injury was done, and treatment with fluid, hemodialysis, and right lower extremity double-compartment fasciotomies have been used. After that, his clinical situation improved, and no other dialysis sessions were required. Cocaine usage has been linked to rhabdomyolysis; nevertheless, compartment syndrome is an extremely uncommon consequence, particularly in the absence of severe damage or extended immobility.

摘要

将急性肢体骨筋膜室综合征与可卡因联系起来的研究匮乏。在此,我们报告一例40岁男性,他长期吸食可卡因,因右腿剧痛和肿胀前来急诊室。体格检查发现,他存在显著心动过速、足背动脉搏动消失、小腿肌肉僵硬疼痛,且右腿在右侧卧位睡眠后出现下肢跖反射消失。尿液可卡因药物筛查呈阳性、严重横纹肌溶解和急性肾损伤促使进一步实验室检查。基于右下肢足背动脉搏动消失以及小腿肌肉水肿性改变伴肌周水肿的影像学证据,确诊为骨筋膜室综合征。针对此病例,已发生急性肾损伤,采用了补液、血液透析及右下肢双骨筋膜室切开减压术进行治疗。此后,他的临床状况有所改善,无需再进行其他透析治疗。可卡因使用与横纹肌溶解有关;然而,骨筋膜室综合征是一种极其罕见的后果,尤其是在没有严重损伤或长期固定的情况下。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e013/11059080/08a16c83eb43/cureus-0016-00000057297-i01.jpg

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