Letters

unusual occupational hazard Meralgia paresthetica is a purelysensory neuropathy caused by irritation or compression of the lat-eral femoral cutaneous nerve of the thigh, usually at the point where the nerve enters the thigh under the in-guinal ligament. The condition is fre-quently misdiagnosed, and its true in-cidence may be higher than 4.3 per 10 000 person-years.1 The exact cause of meralgia paresthetica is uncertain, but common contributing causes in-clude obesity, tight clothing around the belt area,2–4 pregnancy and trauma. We present a case of meralgia paresthetica related to the patient’s occupation. A 32-year-old gardener presented with a 2-year history of intermittent burning pain along the anterolateral as-pect of his left thigh. This problem oc-curred only when he used a ride-on lawnmower. He had gained weight (to 121 kg), and his broad utility belt dug into his sides whenever he sat on the lawnmower in the posture shown in Fig. 1. His symptoms were triggered and exacerbated whenever he drove over uneven ground. Examination re-vealed sensory disturbances in the dis-tribution of the lateral femoral cuta-neous nerve (Fig. 1 and Fig. 2). Palpation around the left anterior supe-rior iliac spine elicited tingling in the anterolateral thigh. The results of all investigations, including spino-pelvic MRI, were normal. We diagnosed mer-algia paresthetica, and treated the pa-tient conservatively. Several months later, the patient changed jobs. As a warden, he did not have to use a lawnmower, wore a nar-rower belt and lost weight. He is now symptom-free. There are very few reported cases of occupation-associated meralgia paresthetica.3 This case highlights the need to obtain a complete occupa-tional history and to consider the pos-sibility of meralgia paresthetica in pa-tients presenting with thigh pain, as misdiagnosis may lead to unnecessary and inappropriate treatment.