Disclosures: John C. Gibbons, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 25-year-old male with foot drop

Case Description: The patient presented to outpatient clinic as a referral from the emergency department (ED) for right foot drop and leg pain. He has a history of Human Immunodeficiency Virus (HIV) but has been noncompliant with his antiretroviral therapy. He was diagnosed with cellulitis at 2 separate EDs and discharged on antibiotics with no improvement of the erythema, swelling, or pain in the right leg. Of note, his CD4 levels were not checked at either ED. In the outpatient clinic he endorsed that his leg has been hurting for 2 months, has become increasingly swollen, and has developed weakness in his foot and leg. On examination the patient had allodynia, erythema, and a positive Thompson test on the right calf. His strength on manual muscle testing was 1/5 for dorsiflexion and 4/5 for knee extension. He was also noted to have a visibly displaced fibular head and was unable to fully extend his leg at the knee. A limited diagnostic ultrasound was performed in clinic and showed significant subcutaneous fluid accumulation from proximal calf to distal Achilles obscuring muscle belly. The patient was sent to the ED from the clinic.Assessment/

Results: His CD4 levels were 120, changing his diagnosis to Acquired Immunodeficiency Syndrome (AIDS). CT scan showed a multi-loculated abscess measuring 11.6 cm. He was taken to the operating room for an incision and drainage. At the one-month follow up he was fully ranging the ankle and knee. He was also ambulating pain free with weight-bearing as tolerated precautions.

Discussion: This is the first documented case of foot drop caused by a space occupying abscess.

Setting: Outpatient Musculoskeletal Clinic

Conclusion: Untreated HIV/AIDS can result in formation of large abscesses that can grow large enough to cause foot drop. Fortunately, with removal of the abscess recovery is favorable.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/foot-drop-in-a-25-year-old-male-with-human-immunodeficiency-virus-a-case-report/