Peripheral nerve vasculitis presenting as complex regional pain syndrome.
OBJECTIVE
To report the clinical, electrodiagnostic, and pathologic findings in 3 patients who presented with complex regional pain syndrome as their primary manifestation of peripheral nerve vasculitis.


METHODS
Case series.


METHODS
Outpatient clinic in a tertiary care academic medical center.


METHODS
Patient 1 was a 39-year-old woman with a 9-year history of non-length-dependent severe burning pain and swelling in her extremities. Patient 2 was a 67-year-old man with a 2-year history of severe burning pain and swelling in an extremity after a fall. Patient 3 was a 74-year-old man with a 6-month history of severe allodynic pain and atrophy of the right hand after a viral illness


RESULTS
In all 3 cases, clinical and electrodiagnostic testing were suggestive of multiple mononeuropathies. Nerve biopsy either confirmed vasculitis (patient 1) or was suggestive of angiopathy (patients 2 and 3). Immunomodulative therapy led to marked clinical improvement in all 3 cases.


CONCLUSIONS
To our knowledge, this is the first report demonstrating that the inflammatory nerve injury seen with peripheral nerve vasculitis can result in complex regional pain syndrome. Clinical and electrodiagnostic assessments can help in the identification and management of these patients.
Ramchandren
Sindhu
S
Department of Neurology, Wayne State University, Detroit Medical Center, University Health Center 8C20, Detroit, MI 48201, USA. sramchan@med.wayne.edu
Chaudhry
Vinay
V
Hoke
Ahmet
A
Murinson
Beth B
BB
Cornblath
David R
DR
Treisman
Glenn J
GJ
Griffin
John W
JW
D000328:Adult; D000368:Aged; D001160:Arterioles / Q000473:pathology / Q000503:physiopathology; D001369:Axons / Q000473:pathology; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004568:Electrodiagnosis; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D009460:Neurologic Examination; D010525:Peripheral Nerves / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D010523:Peripheral Nervous System Diseases / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology*; D016896:Treatment Outcome; D014657:Vasculitis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology*; D014855:Wallerian Degeneration / Q000209:etiology / Q000473:pathology / Q000503:physiopathology
D007155:Immunologic Factors