A thorny case of spastic paralysis

A 78‐year‐old man presented to the emergency department with severe left thigh pain. The patient's past medical history included mild asthma, trigeminal neuralgia and glaucoma. At triage, he appeared in obvious pain and was diaphoretic. Examination of his thigh demonstrated small superficial abrasions with surrounding erythema but no features of compartment syndrome. Initial investigations revealed evidence of systemic inflammation, with elevated white cell count (24.6 × 10⁹ cells/L; reference interval [RI], 4–11 × 10⁹/L) and C‐reactive protein (23 mg/L; RI, < 10 mg/L). There was also evidence of acute kidney injury complicating rhabdomyolysis, with estimated glomerular filtration rate 43 mL/min/1.73m² (RI, > 90 mL/min/1.73m²) and creatinine kinase 980 U/L (RI, 60–285 U/L). A computed tomography scan of the left thigh was unremarkable.