Radial nerve palsy caused by a rapidly growing intramuscular hematoma in an infant with biliary atresia: a case report

BMC Pediatrics

Case Report

Yusuke Morishita¹  Katsuhisa Kawanami¹  Kohei Kawahara²  Shingo Numoto²  Ryosuke Miyamoto²  Akihisa Okumura²  Hitoshi Honma²  Hideyuki Iwayama²  Nami Nakamura²  Nozomi Matsushita³  Shoko Kato³  Kenitiro Kaneko³  Koki Ota⁴ 

[1] Department of Orthopedics, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan;Department of Pediatrics, Aichi Medical University School of Medicine, 1-1, Yazakokarimata, 480-1195, Nagakute, Aichi, Japan;Department of Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan;Postgraduate Clinical Training Center, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan;

关键词: Biliary atresia;    Vitamin K deficiency bleeding;    Intramuscular haematoma;    Radial nerve palsy;    Wrist drop;   

DOI  :  10.1186/s12887-023-04071-5

 received in 2022-02-10, accepted in 2023-05-12,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundBiliary atresia (BA) is a rare cause of persistent jaundice in infants that can result in vitamin K malabsorption and vitamin K deficiency bleeding (VKDB). We present an infant with BA who developed a rapidly growing intramuscular hematoma in her upper arm after a vaccination which caused a radial nerve palsy.Case presentationAn 82-day-old girl was referred to our hospital because of a rapidly growing left upper arm mass. She had received three doses of oral vitamin K before age 1 month. At age 66 days, she received a pneumococcal vaccination in her left upper arm. On presentation, she showed no left wrist or finger extension. Blood examination revealed direct hyperbilirubinemia, liver dysfunction, and coagulation abnormalities, indicating obstructive jaundice. Magnetic resonance imaging showed a hematoma in the left triceps brachii. Abdominal ultrasonography revealed an atrophic gallbladder and the triangular cord sign anterior to the portal vein bifurcation. BA was confirmed on cholangiography. VKDB resulting from BA in conjunction with vaccination in the left upper arm were considered the cause of the hematoma. The hematoma was considered the cause of her radial nerve palsy. Although she underwent Kasai hepatic portoenterostomy at age 82 days, the obstructive jaundice did not sufficiently improve. She then underwent living-related liver transplantation at age 8 months. The wrist drop was still present at age 1 year despite hematoma resolution.ConclusionsDelayed detection of BA and inadequate prevention of VKDB can result in permanent peripheral neuropathy.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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