SHM Converge Scientific Abstract ePoster Gallery-Let's Talk Smack: Social History Confidentiality Is Key

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This case report describes a 17-year-old girl who presented with 2 days of progressive left leg numbness, weakness, and inability to walk. She had a history of heroin use and reportedly had been abstinent for 3 months, but a confidential social history later revealed she had relapsed the day before presentation and injected heroin into her left antecubital area. She awoke with left thigh swelling and her leg in severe external rotation, suggesting a prolonged period of compression or immobilization. She also developed facial swelling and an itchy, scaly rash on her face and left arm.<br /><br />On exam, she had left leg weakness and numbness, facial edema, and distinctive skin lesions. Labs showed severe rhabdomyolysis with CK 57,000 IU/L, elevated AST/ALT, inflammatory markers, leukocytosis, and elevated troponin, though kidney function, ECG, and echocardiogram were normal. MRI showed myositis of the left pyriformis and deep fascial inflammation. She was initially treated with antibiotics because of concern for infection, but blood cultures were negative.<br /><br />Her neurologic deficits improved rapidly with supportive care and resolved completely within 48 hours. CK decreased with IV hydration. Her rash improved significantly with topical fluocinonide, consistent with a fixed drug eruption. The authors conclude this was a transient heroin-related neuropathy with non-traumatic rhabdomyolysis and a fixed drug eruption.<br /><br />They emphasize that this may be the first reported pediatric case of heroin-related neuropathy and rhabdomyolysis, and the first with a fixed drug eruption. The key lesson is that obtaining a confidential adolescent social history was essential to identifying the heroin relapse and making the correct diagnosis.

Asset Subtitle

Vanessa McFadden

Meta Tag

Author List Natalya M. Beneschott, Sheila Swartz, Vanessa McFadden

Category Clinical Vignettes

Concept Heroin

Concept Rhabdomyolysis

Concept Neurologic complication

Concept Musculoskeletal complication

Concept Fixed Drug Eruption

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Vanessa McFadden

Track Pediatric

Keywords

heroin-related neuropathy

rhabdomyolysis

fixed drug eruption

adolescent heroin use

left leg weakness

compression neuropathy

myositis

pediatric case report

confidential social history

intravenous heroin injection

Heroin

Rhabdomyolysis

Neurologic complication

Musculoskeletal complication

Fixed Drug Eruption