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 Hickman line experienced severe back pain after a chemotherapy infusion commenced and developed a right quadriceps weakness and absent knee jerk. OBJECTIVES: To highlight the severe side effects possible with the use of Hickman lines and chemotherapy. SUMMARY OF BACKGROUND DATA: There are numerous causes of lumbar radicular pain, and these can coexist in the same patient. This patient had a known malignant process involving the retroperitoneum, but the actual cause of the severe pain related to the management of the malignancy rather than the malignancy itself. 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 infusion of chemotherapy for an inoperable cholangiocarcinoma. The patient went on to develop a right quadriceps weakness before the investigations could reveal the cause of the problem. RESULTS: the pain and weakness resolved after cessation of the infusion and removal of the Hickman line. CONCLUSIONS: The principles of clinical medicine involve careful history taking and examination and considering all the differential diagnoses fully. Also, the possibility of multiple pathology and iatrogenic causes should be assessed. This patient was receiving palliative treatment only, and this unfortunately led to additional disability, which may have been avoidable or less severe.