Recurrent Viral-Induced Compartment Syndrome

Abstract

Rhabdomyolysis and compartment syndrome are rare but a limb-threatening complication of viral myositis. Because of the potential for severe consequences of compartment syndrome, clinicians should maintain a high index of suspicion when examining children with rhabdomyolysis due to viral myositis. We report a case of recurrent bilateral thigh compartment syndrome in a patient with influenza A, subtype pandemic H1N1-2009. An 8-year-old girl with a history of rhabdomyolysis, acute renal failure, and compartment syndrome secondary to parainfluenza infection that resulted in release of her lower limb compartments presented with a 3-day history of flu symptoms and increasing bilateral thigh pain. Compartment syndrome was confirmed by intracompartmental pressure measurements and comparison of intracompartmental pressure measurements to diastolic blood pressure. The compartments were released. She also experienced acute renal failure, which was treated by continuous renal replacement therapy and hemodialysis. At her most recent orthopedic follow-up, she was doing well. This is the first reported case of recurrent rhabdomyolysis and compartment syndrome as a complication of viral myositis. This case highlights the importance of maintaining a high index of suspicion for compartment syndrome in the child with viral myositis.