Answer: Bilateral femoral neuropathy due to bilateral iliopsoas hematoma in a young patient with acute myocardial infarction

Spontaneous unilateral iliopsoas hematomas secondary to the use of anticoagulants are increasingly documented in the published reports, but bilateral occurrence is uncommon. Table 1 summarizes the previous reported cases in the published reports. The incidence of major bleeding during various lytic treatments is approximately 3 times higher than heparin alone. The overall incidence of hemorrhagic complications and intracranial hemorrhage are 10% and 0.8%, respectively.1 Various medications have been implicated including antiplatelet agents, and oral and intravenous anticoagulants in different clinical settings such as deep vein thrombosis (DVT), transient ischemic attack (TIA), and myocardial infarction (MI) prophylaxis.2-7 Bleeding is an unwanted complication despite the proper selection of patients and therapeutic monitoring. Common bleeding sites are gastrointestinal tract, soft tissue, and urinary tracts. Unusual sites of bleeding, such as iliopsoas muscles, can be overlooked due to their varied presentation and rarity. The subject of iliopsoas hematomas in acute coronary disease setting has been exhaustively reviewed by Sasson et al. who reported unilateral iliopsoas hematomas in 3 elderly females (aged 73,79, and 67 years) receiving intravenous (IV) heparin.8 They suspected that this complication might be related to advanced age and female gender. Enoxaparin-associated iliopsoas hematoma was also reported in an elderly 83-year-old female with acute non-