Sciatic Nerve Neuropathy Secondary to Sacral Pressure Ulcer Following COVID-19: A Case Report

TL;DR

A young man developed sciatic nerve damage and a severe sacral pressure ulcer after prolonged mechanical ventilation for severe COVID-19, showing the need for early preventive care in ICU patients.

Contribution

This case highlights the intersection of pressure-related and neurological complications in critically ill COVID-19 patients.

Findings

The patient had distal sensorimotor polyneuropathy and chronic proximal sciatic neuropathy confirmed by imaging.

Treatment with pregabalin led to complete resolution of symptoms with no residual neurological deficits.

The case underscores the importance of early preventive strategies like frequent repositioning in ICU care.

Abstract

We report the case of a previously healthy 25-year-old man who developed severe SARS-CoV-2 infection requiring prolonged mechanical ventilation. Following extubation, he presented with peripheral sensory deficits and a sacral pressure ulcer. He was later admitted to our service with fever and a Grade IV ulcer, which required surgical debridement, negative pressure wound therapy, and definitive reconstruction using a V-Y gluteal flap. Examination of the right leg at admission demonstrated a neuropathic pain pattern, with neurological evaluation and imaging confirming distal sensorimotor polyneuropathy and chronic proximal sciatic neuropathy. Treatment with pregabalin led to complete resolution of symptoms, with no neurological deficit or residual pain identified during follow-up. This report suggests a plausible intersection between pressure-related and neurological complications in critically ill COVID-19 patients and highlights the importance of early preventive strategies such as frequent repositioning and multidisciplinary ICU care.

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