DERM DIAGNOSES

MARC R. SALZBERG, MD, FACEP

The patient pictured presented with two hours of intense pain and redness along the left side of her head and down her left arm.

Though this could easily be mistaken for an infectious process, it was actually reflex sympathetic dystrophy (RSD), also referred to as complex regional pain syndrome (CRPS) type I.

By any name, however, this is a rare and poorly understood neurological condition. It may manifest by way of sensory, focal autonomic, or motor abnormalities. Pain is a common presenting complaint; cutaneous vasomotor changes may also be present, as was the case with this patient.

The patient was treated for the acute symptoms in the urgent care setting with the standard of care for this syndrome —diazepam, gabapentin (Neurontin), and acetaminophen/ oxycodone (Percocet)—and referred to a neurologist, in whose care she underwent ganglion steroid injections. She experienced slight resolution of symptoms and then remained asymptomatic for three months.

She presented to urgent care again when the condition flared, despite the fact that she was on medication. She is still under the neurologist’s care and does not have a very good prognosis, as this entity tends to get worse despite treatment.

Typically, the prognosis for such patients is hard to predict; however, in some patients the condition spreads to other areas of the body.