Conflict of Interests/Disclosure Summary: All authors and contributors have no conflict of interests and have nothing to disclose.
Complex Regional Pain Syndrome Secondary to Leprosy
Article first published online: 3 JUL 2012
Wiley Periodicals, Inc.
Volume 13, Issue 8, pages 1067–1071, August 2012
How to Cite
Ghia, D., Gadkari, R. and Nayak, C. (2012), Complex Regional Pain Syndrome Secondary to Leprosy. Pain Medicine, 13: 1067–1071. doi: 10.1111/j.1526-4637.2012.01426.x
- Issue published online: 16 AUG 2012
- Article first published online: 3 JUL 2012
- Brachial plexopathy;
- Sympathetic Block
Introduction. Leprosy is a chronic infectious disease caused by Mycobacterium leprae affecting the skin and the nerves. Complex regional pain syndrome (CRPS/Sudeck's dystrophy) is a painful and disabling condition—a triad of autonomic, sensory, and motor symptoms disproportionate to the inciting event (inflammatory, infective, or traumatic nerve damage).
Case. A 20-year-old male presented with continuous pain, aggravated by cold and emotions, loss of fine touch and temperature sensation, redness, swelling, along lateral aspect of left hand and forearm with weakness in the grip of 6 months' duration. There was a 5-year history of sensory loss only over left index finger that he ignored. Examination revealed abnormal sensory and autonomic functions along left radial and median nerve distribution that were confirmed by nerve conduction studies suggestive of mononeuritis multiplex. Radial cutaneous nerve biopsy was suggestive of leprosy. Magnetic resonance imaging and ultrasonography showed no compressive etiology; however, MRI showed involvement of brachial plexus. Antileprosy, anti-inflammatory drugs, and steroids were given in view of neuritis because of lepra reaction with supportive measures of physiotherapy, transcutaneous electrical nerve stimulation, to no avail. A surgical median nerve decompression also failed to relieve the pain. Temporary stellate ganglion block improved the pain scale. Thus, excluding all other causes, the final diagnosis was CRPS secondary to leprosy. There is only one reported case of CRPS with leprosy.
Conclusion: Leprous neuropathy caused the nerve damage that lead to CRPS type 2. Very rarely leprosy can lead to CRPS. CRPS is a diagnosis of exclusion.