Rhabdomyolysis induced neuropathy: A unique case of foot drop

Rhabdomyolysis induced neuropathy in chronic alcoholic patients is a rare but extremely consequential phenomenon that poses significant challenges to the Internal Medicine, Neurology and Nephrology teams involved. Establishing etiology of an idiopathic foot drop, such as in this case, is very challenging due to its rare presentation and limited research. A 59 y/o male with pmhx of hypertension, diabetes, gout, alcohol and methamphetamine abuse was brought to the hospital after he was found unconscious on the floor at home. He was diagnosed with acute toxic encephalopathy, acute kidney injury secondary to rhabdomyolysis with creatinine kinase of 43,875 in the context of alcohol and methamphetamine intoxication. He was treated with aggressive fluid therapy and was stabilized. Four days into his recovery, he developed sudden onset non-painful complete sensory and motor function loss in the left lower extremity, from the ankle down. Losing the ability to dorsiflex, plantar flex and wiggle any toes. MRI of the lumbar spine showed fluid in the bilateral facet joints at L4-L5, synovial cyst in the L4-L5 canal as well as an abscess in the right paraspinal muscles concerning for an abscess. In this study we explore this unique presentation of foot drop due to possible mononeuritis multiplex vs rhabdomyolysis induced nerve damage. Metabolic changes associated with long-term excessive alcohol consumption may increase the risk of neuropathy in patients with rhabdomyolysis. It is also important to have high suspicion for mononeuritis multiplex due to an unusual unilateral distribution of the distal extremity. It is crucial to be able to recognize the clinical presentation to prevent permanent neuropathic injury.