key: cord-0815039-b86itz8z
authors: Zhou, Lan; Siao, Peter
title: Lateral femoral cutaneous neuropathy caused by prone positioning to treat COVID‐19‐associated acute respiratory distress syndrome
date: 2021-03-27
journal: Muscle Nerve
DOI: 10.1002/mus.27202
sha: 40e970632332b812c10c1d384a7dcc52b1564929
doc_id: 815039
cord_uid: b86itz8z

nan

report another two patients with typical sensory symptoms, in whom the diagnosis of severe lateral femoral cutaneous neuropathy was confirmed by LFCN nerve conduction study (NCS) and skin biopsy. Needle EMG showed a few fibrillation potentials in the right rectus femoris muscle, and some large-amplitude and long-duration motor unit potentials with mildly reduced recruitment in the L2-S1 myotomes bilaterally. To date, the patient has declined a lumbosacral spine MRI. Skin biopsy showed absent IENFs at the left proximal thigh, reduced IENF density at the right proximal thigh, but normal IEFN density at the left distal leg (Figure 1) . He was diagnosed with severe, left > right, lateral femoral cutaneous neuropathy induced by prone positioning.

As COVID-19 cases continue to increase, we may see an increasing number of patients with lateral femoral cutaneous neuropathy caused by prone positioning to treat ARDS. However, the neuropathy may be preventable by using egg-crate style foam padding between hip and bed to achieve more evenly distributed pressure over the hip to avoid LFCN compression. 5 It is important to take preventive measures, as the neuropathy can be severe, disturbing, and protracted as seen in our patients. Skin biopsy is useful to confirm lateral femoral cutaneous neuropathy, 1 as LFCN conduction response can be difficult to obtain in obese or older patients. 6 The mild chronic polyradiculopathy in our patients was most likely caused by spine degenerative disease, given the history and lumbosacral spine MRI findings. There was no history to suggest inflammatory polyradiculoneuropathy, which can be a neurological complication of COVID-19. 7

None of the authors has any conflict of interest to disclose.

We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

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