title: Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis.
abstract: Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient's symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized.
authors.affiliation: Department of Internal Medicine and Rheumatology, Asian Institute of Medical Sciences, Faridabad, India.
authors.forename: Punit
authors.identifier: 0000-0003-3751-1106
authors.initials: P
authors.lastname: Pruthi
authors.affiliation: Department of Nuclear Medicine, Asian Institute of Medical Sciences, Faridabad, India.
authors.forename: Pramod
authors.initials: P
authors.lastname: Arora
authors.affiliation: Department of Radiodiagnosis, Asian Institute of Medical Sciences, Faridabad, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Mittal
authors.affiliation: Department of Internal Medicine and Rheumatology, Asian Institute of Medical Sciences, Faridabad, India.
authors.forename: Anugrah
authors.initials: A
authors.lastname: Nair
authors.affiliation: Department of Internal Medicine and Rheumatology, Asian Institute of Medical Sciences, Faridabad, India.
authors.forename: Waqia
authors.initials: W
authors.lastname: Sultana