RT Book, Section
A1 Arnold, W. David
A1 Freimer, Miriam L.
A2 Dean, Steven M.
A2 Satiani, Bhagwan
A2 Abraham, William T.
SR Print(0)
ID 1105292824
T1 ERYTHROMELALGIA
T2 Color Atlas and Synopsis of Vascular Diseases
YR 2015
FD 2015
PB McGraw-Hill Medical
PP New York, NY
SN 9780071749541
LK accesssurgery.mhmedical.com/content.aspx?aid=1105292824
RD 2024/04/23
AB A  52-year-old  woman  with  controlled  hypothyroidism  presented  for  symptoms  of  painful  burning  and  discolored  feet.  She  reported  1  to  2  years  of  progressive  disabling  lower  limb  burning  pain  and  numbness  associated  with  fluctuating  skin  discoloration.  Her  symptoms  were  worsened  with  lower  limb  dependency,  warmth,  and  exertion.  Examination  was  notable  for  erythema  of  the  distal  legs  and  feet  associated  with  slightly  increased  palpable  warmth.  There  was  distal  pain  and  temperature  sensation  loss  with  relative  preservation  of  vibration  and  position  sense.  Distal  pulses  were  normal  as  were  strength  and  muscle  stretch  reflexes.  Her  workup  included  electromyography  and  nerve  conduction  studies  that  confirmed  a  length-dependent,  predominantly  axonal  neuropathy.  Skin  biopsy  showed  severely  diminished  intraepidural  nerve  fiber  density  consistent  with  small  fiber  neuropathy.  Laboratory  evaluation  demonstrated  an  elevated  hemoglobin  A1c  of  9%,  but  otherwise  no  additional  contributing  factors  were  identified.  She  was  diagnosed  with  small  fiber  predominant  neuropathy  related  to  diabetic  mellitus  and  secondary  erythromelalgia  (EM).  Management  of  her  diabetes  and  symptomatic  treatment  with  gabapentin  resulted  in  partial  pain  relief.