Complex Regional Pain Syndrome after Vaccination

A 17-year-old woman with no specific medical history received the first dose of Pfizer/BioNTech mRNA COVID-19 vaccine on her left upper arm, which caused mild swelling at the site of injection and resolved quickly. Three weeks later, the second dose of the vaccine was administered to her left upper arm, and after a fever which resolved within a few hours, a bruise appeared on the back of her left hand that spread to her entire left hand, became edematous and caused severe pain. 

The bruise gradually resolved, but the pain and swelling persisted. Six weeks later, she was diagnosed with Complex Regional Pain Syndrome (CRPS) and received a stellate ganglion block.
Two months after second dose of the vaccine, numbness and involuntary flexion of the right hand and fingers began to appear.  Four months later, she developed involuntary movements with pain in her right index finger. She was prescribed medication for the involuntary movements, but it did not improve her symptoms. Seven months after receiving the vaccine, she was referred for surgical treatment of the movement disorder. An injection and a medication were administered, which resulted in a definite improvement of the involuntary movements in her right hand but did not improve the limited range of motion in her left hand.

CRPS is a rare condition and is thought to be caused by changes in the way that the nervous system processes pain signals. In some cases, CRPS may be triggered by an injury such as vaccine injection trauma or other event that damages or irritates the nerves. In other cases, the condition may be caused by changes in the way that the brain and spinal cord process pain signals. 

CRPS after COVID-19 vaccination was previously observed in a 33-year-old woman after the first dose of a COVID-19 vaccine. It was also described post vaccination of influenza A (H1N1) and post hepatitis vaccination in adolescents and children. 


REFERENCES

Horisawa S, Ando T, Kawamata T, Taira T. Complex regional pain syndrome after mRNA-based COVID-19 vaccination. Clin Neurol Neurosurg. 2022 Dec 28;224:107578. doi: 10.1016/j.clineuro.2022.107578. Epub ahead of print. PMID: 36584585; PMCID: PMC9796353.

Raman P. Complex Regional Pain Syndrome Post COVID-19 Vaccine Shot: An Autobiographical Case Report. Cureus. 2021 Dec 8;13(12).


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