Can’t stand – bilateral leg weakness

Author: Ella J Harrison-Hansley, Imran Mohamed / Editor: Ryan Hobbs / Reviewer: Tom White / Codes: A6Published: 18/04/2022

A 25-year-old male presented with a five day history of bilateral muscular leg pain.

He noticed bilateral calf swelling five days earlier, which eased after 24 hours. He attended the Emergency Department, as he was now unable to stand or support his own body weight. He complained of muscle tightness spreading up his legs into his thighs. He reported similar tightness in his arms and shoulders.

He denied any other pain. He denied dysuria.

He reported one episode of diarrhoea one day before presentation.

He had no breathing difficulties.

PMH: Nil.

DH: Admitted to anabolic steroid use, both oral and intramuscular.

SH: Non-smoker, No alcohol. Heavy gym user.

On Examination:

Obs: P 85  BP 132/68  RR 20  sats 98% on Air Temp 36.4  BM 6.8  GCS 15/15. PEARLA.

Chest clear. Heart sounds normal. Abdomen soft, non-tender.

Cranial Nerves Normal

Peripheral Neurology:

Right Upper Limb Left Upper Limb Right Lower Limb Left Lower Limb
Inspection muscle mass muscle mass muscle mass muscle mass
Tone Normal Normal Normal Normal
Power 4 4 1 1
Sensation Normal Normal Normal Normal
Reflexes Present Present Difficult to assess Difficult to assess
Co-ordination Normal Normal Unable to assess Unable to assess


ECG (see attached)


WCC 14.9 Na+ 141 Glucose 6.9
Hb 158 K+ 2.3 CRP <5
Plt 345 Urea 2.5 LFTs normal
MCV 85 Creat 67 Calcium 2.25
Magnesium 0.75 CK 887

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