AN UNUSUAL PRESENTATION OF ACUTE LUMBAR NERVE ROOT PAIN - A CASE-REPORT

Study Design. This case report illustrates the need to be vigilant of potential iatrogenic causes of symptoms. A patient with a femoral Hick man line experienced severe back pain after a chemotherapy infusion co mmenced and developed a right quadriceps weakness and absent knee jerk . Objectives. To highlight the severe side effects possible with the u se of Hickman lines and chemotherapy. Summary of Background Data. Ther e are numerous causes of lumbar radicular pain, and these can coexist in the same patient. This patient had a known malignant process involv ing the retroperitoneum, but the actual cause of the severe pain relat ed to the management of the malignancy rather than the malignancy itse lf. There are no reported cases of such a complication from a Hickman line. Methods. This patient was admitted to hospital for investigation and treatment of severe back pain after the start of a continuous inf usion of chemotherapy for ail inoperable cholangiocarcinoma. The patie nt went on to develop a right quadriceps weakness before the investiga tions could reveal the cause of the problem. Results. The pain and wea kness resolved after cessation of the infusion and removal of the Hick man line. Conclusions. The principles-of clinical medicine involve car eful history taking and examination and considering all the differenti al diagnoses fully. Also, the possibility of multiple pathology and ia trogenic causes should be assessed. This patient was receiving palliat ive treatment: only, and this unfortunately led to additional disabili ty, which may have been avoidable or less severe.