Ulnar neuropathy after glatiramer acetate subcutaneous injection: Ultrasound findings

We have read the paper by Villaverde Piñeiro and colleagues, enti‐ tled “Paralysis of the external popliteal sciatic nerve associated with daptomycin administration.”1 The authors present a very interesting case of a 62‐year‐old man showing a toxic neuropathy, 22 days after daptomycin therapy. The patient developed a foot drop, and iatro‐ genic fibular neuropathy was suspected. The paper is informative, because it sheds light on possible side effects of some drugs, involv‐ ing the nervous system. Furthermore, the genetic evaluation and the suggested association between metabolism and the side effects are very interesting. The authors also used neurophysiological exam‐ ination in their evaluation.1 This approach is valuable, but we would like to suggest to the authors that imaging may be profitable in peripheral nerve assessment. Furthermore, we would like to report a likely drug‐related neuropathy from a local drug administration. Indeed, in the case by Villaverde Piñeiro and colleagues, the drug might have caused the neuropathy by a toxic mechanism possibly linked to a metabolic alteration, but other type of damage could be associated with drug administration procedures.1 We present a case of 30‐year‐old woman, with multiple sclero‐ sis, who complained of left ulnar nerve pain immediately after glati‐ ramer acetate (GA) subcutaneous injection in the posterior side of the left arm. The patient reported an “electrical shock” sensation during the injection. Our clinical evaluation showed weakness of the intrinsic muscles of the left hand and sensory deficit in the ulnar