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.
Highlights
Complex regional pain syndrome (CRPS) is a pain disorder characterized by spontaneous pain, usually triggered by a noxious stimulus like trauma which may be trivial, immobilization, and postacute illnesses like myocardial infarction or stroke
The clinical course of CRPS was traditionally divided into acute, dystrophy, and atrophy stages based on duration of illness and symptomatology [1]
The evolution of CRPS into these three stages has been questioned and stages have been removed from the taxonomy and two types, acute/warm for the acute CRPS, transcutaneous electrical nerve stimulation, spinal cord stimulation, regional sympathetic blockades, surgical sympathectomy, and occupational therapy have been used with limited success [2, 7, 10]
Summary
Complex regional pain syndrome (CRPS) is a pain disorder characterized by spontaneous pain, usually triggered by a noxious stimulus like trauma which may be trivial, immobilization, and postacute illnesses like myocardial infarction or stroke. In around 10% of cases no inciting cause is identified [1]. CRPS was traditionally divided into type 1 and type 2, depending on the absence or presence of a preceding peripheral nerve injury [1]. The diagnosis is made as per the Budapest criteria, according to which patients should have continuing pain disproportionate to the inciting event [4]. CRPS is diagnosed if the patient has at least one sign in two or more categories and at least one symptom in three or more categories, in the absence of alternative explanations [4]. We report a case of a young male who developed joint symptoms one day after blood sample withdrawal
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