Atypical presentation of complex regional pain syndrome: neuropathic itching - A case report

Abstract

Background: In some patients with neuropathic pain (NP), such as complex regional pain syndrome (CRPS), itching rather than pain is the main symptom making diagnosis and treatment difficult.

Case: We report a case of a 23-year-old male with a history of hypoxic brain damage who presented with pruritus of the left foot and ankle. His left foot was fractured, and he underwent surgery 6 months previously. After the operation and cast application, he developed uncontrolled pruritus, swelling, sweating, and flushing of the left foot skin with limping. On examination, he showed well-known features of CRPS without pain. He was diagnosed with an atypical CRPS with neuropathic itching (NI). With treatment modalities used for NP and CRPS, his pruritus subsided gradually, and the his ankle mobility improved.

Conclusions: Unexplained itching can be the main symptom in some CRPS patients. Treatment according to NP can improve symptoms of NI in CRPS patients.

Keywords: Complex regional pain syndrome; Fracture; Itch; Neuropathic itch; Neuropathic pain.

Fig. 1.

Magnetic resonance imaging of the brain shows multiple chronic cerebral infarctions at both the parieto-occipital lobes and left anterior watershed zone and thinning of the posterior portion of the corpus callosum (A). Multifocal small lacunar infarctions are also seen in the left cerebellum (B).

Fig. 2.

The three-phase bone scan shows diffusely increased perfusion, blood pool, and delayed bone uptake in the left foot and ankle. ^99mTc-DPD: ^99mTc-3, 3-diphosphono-1, 2-propanodicarboxylic acid, IV: intravenous.