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 2024/10/14 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.