Novel treatment modality in a case of resistant erythromelalgia

Abstract

<p>Erythromelalgia presents with redness, pain and warmth of the extremities, which is exacerbated by warming and relieved by cooling. Treatment of pain in erythromelalgia can be difficult, and often polypharmacy is utilized. No single therapy has been found to provide complete relief for any patient. Therefore, a multidisciplinary approach is required to treat pain and its significant negative impact across many domains of functioning. A 21 year old male diagnosed case of primary erythromelalgia since 5 years, presented multiple times with recurrent pain and erythema in bilateral lower limbs. Patient was treated initially with oral antibiotics, tramadol and prednisolone, without relief. Aspirin, amitriptyline, pregabalin, carbamazepine, atenolol were later added which gave him partial relief. Epidural caudal catheter with daily infusion of anesthesia was added along with topical buprenorphine patch when conservative polypharmacy failed to provide complete relief and later unilateral lumbar sympathectomy was done as a last resort. Adding pentoxifylline and compression therapy improved the patient’s condition drastically and complete remission is in progress. The patient required a multidisciplinary approach for pain management and surgical intervention was required due to his refractory nature. However, this also does not give complete relief and thus a combination of both medical and surgical methods is required for best control of symptoms.</p>