Though this could easily be mistaken for an infectious process, the correct diagnosis is reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome (CRPS) type I.
This is a poorly understood neurological condition that may manifest by way of sensory, focal autonomic, or motor abnormalities. Pain is a common presenting complaint; as was the case with this patient, cutaneous vasomotor changes also may be present.
This 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. Prognosis for RSD/CRPS is hard to predict; in some patients, the condition spreads to other areas of the body.
Case presented by Marc R. Salzberg, MD, FACEP of Stat Health Immediate Medical Care, PC, Smithtown, NY.
[taq_review]
