Meralgia Paraesthetica after Prone Position Ventilation in a
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COVID-19 may require intubation and mechanical ventilation because of respiratory distress. Prone position ventilation improves oxygenation, but may cause lateral femoral cutaneous nerve entrapment and meralgia paraesthetica. Medical personnel should be aware of the risk of meralgia paraesthetica as a disabling condition potentially affecting more patients as the COVID-19 pandemic persists.

A 52-year-old man was admitted to hospital for fever and dyspnoea. He had a medical history of well-controlled hypertension (home therapy with ramipril and doxazosin) and previous L5–S1 decompression surgery in 2005, with no post-operative complications. He denied alcohol abuse and cigarettes smoking. His body mass index was normal (22). COVID-19 infection was confirmed by a SARS-CoV-2 positive nasopharyngeal swab. Soon after admission, non-invasive ventilation (NIV) was started. A chest x-ray revealed infiltrates in the right lower lobe.

On day 3, because of clinical worsening, was admitted to ICU and underwent mechanically assisted ventilation. The patient received antiretroviral therapy and tocilizumab. On day 21, prono-supination cycles were started (16 hours of pronation and 8 hours of supination) and continued until day 39, when the patient was extubated. In the following days, the patient complained of burning pain and dysaesthesia on the lateral surface of the thigh bilaterally. Consequently, after a neurological consultation, he underwent a lumbo-sacral MRI, which showed an L4–L5 disc herniation pressing on the dural sac.

One month later, on day 69, the patient was admitted to the neuro-rehabilitation unit. On admission to the unit, he had bilateral muscle weakness of the dorsal extensor muscles of the foot, most evident in the right side. Walking was uncertain and difficult, and only possible with the aid of a walker. In addition, the patient had bilateral hypoesthesia affecting the anterolateral surface of the thigh, associated with burning dysaesthesia. Bilateral MP was suspected. The diagnosis was confirmed with a nerve conduction study showing that nerve action potentials of the LFCN could not be obtained on either side. Electromyography (EMG) from the quadriceps muscle showed no signs of denervation, suggesting no involvement of the lumbar plexus.

On day 87, the patient was discharged home. He was able to walk without aid. Hypoesthesia and burning dysaesthesia of the antero-lateral surface of the thigh were still present bilaterally.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/2039/2448
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