Poster 150: Sciatic Nerve Palsy Secondary to Spontaneous Large Gluteal Hematoma With Enoxaparin: A Case Report

Abstract

Setting: Tertiary care hospital. Patient: A 43-year-old lady with multiple medical problems including SLE, antiphospholipid syndrome, history of multiple deep venous thrombosis, and pulmonary embolisms, on enoxaparin, with low back pain (LBP) and history of hemorrhagic cerebrovascular accident. Case Description: The patient (weight, 127kg) was on 120mg of enoxaparin subcutaneously BID for anticoagulation. She was admitted to medicine floor with 1 week of worsening LBP radiating to left lower extremity and new onset of left lower-extremity weakness. She denied any traumatic event to her low back and left leg. Magnetic resonance imaging of lumbar spine showed mild disk bulging and facet and ligamentous hypertrophy at L4-5, without significant neural compression. Routine admission blood test revealed decreased hemoglobin and hematocrit to 5.7 and 17.4 from 13.1 and 38.2 one week earlier and physical exam found large ecchymosis at left buttock, thigh and groin regions, and complete sciatic nerve palsy. Computed tomography of left thigh revealed a large left gluteal hematoma extending inferiorly within the biceps femoris compartment. Enoxaparin was discontinued, and the patient was transferred to acute inpatient rehab unit. Assessment/Results: Electromyography confirmed left sciatic nerve lesion with signs of increased insertional activity in the tibialis anterior, peroneus longus, and medial head gastrocnemius, significant 3+ fibs/positive sharp waves in the peroneus longus and gastrocnemius medial head. Left semimembranosus and vastus medialis showed decreased recruitment with normal insertional activity. Patient’s function improved in spite of left sciatic nerve palsy. Discussion: This is the first reported case, to our knowledge, of intermuscular hematoma causing complete sciatic nerve palsy with therapeutic dose of enoxaparin. Conclusions: Spontaneous intermuscular bleeding is one of potential adverse effects, needing close surveillance and vigilance.