J Korean Soc Emerg Med.  2008 Aug;19(4):434-437.

A Case of Gluteal Myonecrosis Aggravated after Discharge by Intoxication with Several Drugs Including Tricyclic Antidepressants (TCA)

• Lim H
• Cho YS
• Kim HJ

Abstract

TCA are used for the treatment of major depression, anxiety disorders, eating disorders, chronic pain syndromes, and peripheral neuropathies associated with psychiatric and medical conditions that call for a higher rate of prescription drugs. Frequently observed toxic symptoms are sinus tachycardia and altered mental status. Severe toxic symptoms include altered mental status, dysrhythmia, seizure, and secondary complications. Serious cardiotoxicity can lead to ventricular dysrhythmia and a classic TCA electrocardiogram. Gluteal myonecrosis is reported in postoperative alcoholic states, unconscious conditions where patients remain in one position over a long period of time, strenuous physical training, or in crushing injuries. We report a case of gluteal myonecrosis after treatment with several drugs including TCA resulted in intoxication. The patient was mentally drowsy and had been lying down for 20 hours upon discovery. The patient presented on arrival to the ER with cardiotoxicity secondary to TCA intoxication and was treated. Two weeks following the incident, she complained of pain in the gluteal area. Subsequent management and investigation revealed that her gluteal myonecrosis was a result of delayed complication from a prolonged recumbent position and hemolysis due to drug interactions. She eventually recovered without the need for surgery (fasciotomy).

Keyword

Antidepressive Agents; Tricyclic; Necrosis

MeSH Terms

Alcoholics
Antidepressive Agents
Antidepressive Agents, Tricyclic
Anxiety Disorders
Chronic Pain
Deception
Depression
Drug Interactions
Feeding and Eating Disorders
Electrocardiography
Hemolysis
Humans
Necrosis
Peripheral Nervous System Diseases
Prescription Drugs
Seizures
Tachycardia, Sinus
Unconscious (Psychology)
Antidepressive Agents
Antidepressive Agents, Tricyclic
Prescription Drugs