COVID-19 Vaccination-Induced CRPS Masquerading as Erythromelalgia

New case report describes a 56-year-old woman who developed debilitating symptoms, including intense foot pain, discoloration, and swelling, following COVID-19 vaccination with the Pfizer-BioNTech mRNA vaccine.

The patient experienced acrocyanosis, constant pain in the soles of her feet, and a throbbing sensation. Symptoms worsened after each COVID-19 vaccine dose, leading to dependency on a wheelchair. Dermatological manifestations included redness, discoloration, and swelling.

Initial evaluations suggested erythromelalgia, but subsequent investigations involved multiple medical specialties, including dermatology, vascular surgery, rheumatology, neurology, and orthopedics. Various diagnostic tests, including blood tests, genetic testing, imaging, and biopsies, yielded inconclusive results.

Based on the Budapest Criteria for CRPS, the patient fulfilled the criteria, exhibiting allodynia, hyperalgesia, skin color changes, edema, continuing pain, and the absence of a more obvious explanation. The Naranjo Adverse Drug Reaction Probability Scale indicated a probable link between symptoms and COVID-19 vaccination.

We talked about similar cases of CRPS following COVID-19 vaccination in a previous post.  More cases were previously reported, emphasizing the importance of recognizing this potential adverse reaction.

The case highlights the challenge of distinguishing CRPS from other conditions like erythromelalgia and chilblains. Unlike erythromelalgia, the patient's symptoms worsened with cooling, and the dependence on a wheelchair was inconsistent with typical erythromelalgia presentations.

The patient underwent various unsuccessful treatments, including pain-relieving medications, prednisone, nifedipine, fexofenadine, topical capsaicin, and physiotherapy. Plans for cryoneurolysis were canceled due to worsened symptoms during a pre-test regional nerve block.

Early recognition and a multidisciplinary approach to management are crucial for optimizing patient outcomes in CRPS cases.



REFERENCES

Lorentzen KL, Bygum A. COVID-19 Vaccination-related Complex Regional Pain Syndrome Masquerading as Erythromelalgia: A Case Report. Acta Derm Venereol. 2023 Nov 13;103:adv13400. doi: 10.2340/actadv.v103.13400. PMID: 37955530.

Zhang J, Gungor S. Acute worsening of clinical presentation in CRPS after SARS-CoV-2 (COVID-19) vaccination: a case series. Pain Manag 2022; 12: 249–254

Complex Regional Pain Syndrome after Vaccination (aurametrix.com)


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