Bilateral Meralgia Paresthetica With Concurrent Right Piriformis Syndrome Following a Febrile Illness: A Case Report

Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN) that is typically caused by mechanical compression. Piriformis syndrome (PS) is an uncommon neuromuscular disorder resulting from sciatic nerve compression or irritation by the piriformis muscle. The concurrent occurrence of MP and PS is rare and may pose significant diagnostic challenges because of overlapping sensory and radicular-like symptoms. We report the case of a 30-year-old previously healthy man who developed bilateral burning pain over the anterolateral thighs and right gluteal discomfort following a self-limiting febrile illness. Neurological examination demonstrated sensory dysesthesia in the LFCN distribution and a positive flexion-adduction-internal rotation (FAIR) test on the right side. Nerve conduction studies demonstrated bilateral LFCN conduction abnormalities consistent with MP, while pelvic magnetic resonance imaging demonstrated edema and hypertrophy of the right piriformis muscle. The patient demonstrated significant clinical improvement following treatment with pregabalin, nonsteroidal anti-inflammatory drugs, and physiotherapy. This case highlights the importance of considering a possible post-infectious inflammatory association and coexisting entrapment neuropathies in patients presenting with atypical lower-limb sensory symptoms after a systemic febrile illness.