abstract: A 42-year-old patient presented with acute allodynia and hyperalgesia in her distal limbs, most severe in the innervation area of the ulnar nerve. The patient developed critical illness myopathy/polyneuropathy after septic shock 5 months prior to her presentation. After exclusion of differential diagnosis, "late onset small fiber neuropathy" after critical illness was diagnosed. Recent studies showed small fiber lesions during critical illness and in follow-up exams, where additionally neuropathic pain were proved. Dysfunction of voltage-gated Sodium channels related to severe insulin resistance during critical illness might explain the pathophysiology, as seen in critical illness myopathy/polyneuropathy. Therefore we recommend cooling, pharmacotherapy with carbamazepin/oxcarbazepine, tricyclic antidepressive agents and peripheral nerve blocks to treat patients with "late onset small fiber neuropathy" after critical illness.
authors.forename: Susanne
authors.initials: S
authors.lastname: Koch
authors.forename: Rabih
authors.initials: R
authors.lastname: Moshourab
authors.forename: Tobias
authors.initials: T
authors.lastname: Wollersheim
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
authors.forename: Thomas
authors.initials: T
authors.lastname: Fritzsche
authors.forename: Steffen
authors.initials: S
authors.lastname: Weber-Carstens
mesh_terms: D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D016638:Critical Illness; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D011115:Polyneuropathies / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D018805:Sepsis / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D000071075:Small Fiber Neuropathy / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000779:Anesthetics, Local; D000929:Antidepressive Agents, Tricyclic