Vol.103 No.1 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 103 No. 1 January 2010
Complex Regional Pain Syndrome Type I after Lymph
Node Biopsy of the Neck: A Case Report
Kenichiro Yabuki
(Yokosuka City Hospital)
Mamoru Tsukuda
(Yokohama City University)
Yuji Tanigaki, Ken Aiko and Kazuo Koyama
(Fujisawa City Hospital)
Yoichi Ikeda
(Yokohama City University Medical Center)
We report on a case of complex regional pain syndrome (CRPS) type I. A 27-year-old woman underwent lymph node biopsy of the neck to confirm a diagnosis of histiocytic necrotizing lymphadenitis. Four days after the biopsy, she complained of hyperpathia and limited range of motion on the thumb, forefinger and middle finger of the right hand. She was diagnosed as having CRPS with thermography and treated with glucocorticoid, mecobalamin, and nonsteroidal anti-inflammatory drugs (NSAIDs). The symptoms disappeared within a month and no relapse was seen.
CRPS is a disorder of the extremities that is characterized by pain, swelling, limited range of motion, vasomotor instability, skin changes, and patchy bone demineralization. It frequently begins after an injury, surgery, or vascular events, e.g., myocardial infarction or stroke. Tonsillectomy and free forearm flap can cause CRPS.
Two types of CRPS have been reported: type I corresponds to patients with CRPS without a definable nerve lesion. Type II which was formerly termed causalgia refers to cases with a definable nerve lesion. The pathogenesis of CRPS is still unclear. CRPS might be caused by the formation of an abnormal reflex arc between the sympathetic nervous system and peripheral vascular components after a causative event.
The diagnosis of CRPS is difficult, however, symptoms such as characteristic pain including allodynia and hyperpathia, and altered skin temperature are helpful. Autonomic testing such as thermography and bone scintigraphy are also useful.
Prevention and early diagnois are important to treat CRPS. Therefore careful examination and a good understanding of CRPS are recommended.
Key words :complex regional pain syndrome, lymph node biopsy, CRPS