A clinical case of secondary erythromelalgia

Background. Angiotrophoneuroses treatment is supposed to be one of the most sophisticated tasks for neurologists. This is the group of diseases, characterized by impairment of vascular tone regulation. The particular example of angiotrophoneuroses is erythromelalgia (also known as Mitchell syndrome), which results into neuropathic pain, autonomic dysfunction, and dystrophic changes in tissues, therefore poor level of life quality of patients with this condition. Unfortunately, comprehensive understanding of its pathophysiology is missing in view of the fact that itʼs rare and can be masked at the background of other myeloproliferative, demyelinating, metabolic, autoimmune and other diseases. Performing analysis of the clinical case of the secondary form of erythromelalgia gives an opportunity to attract attention of many healthcare specialists, such as neurologists, dermatologists, haematologists, vascular surgeons, etc. It is exceptionally important to highlight this topic, because patients with Mitchell syndrome can search for help visiting the doctors of different specialties. Purpose – to describe the clinical case of erythromelalgia, occurred in the patient with erythremia. Materials and Methods. The results of an objective neurological examination, the DN4 neuropathic pain diagnostic questionnaire and the TSS (Total Symptoms Score) assessment, as well as the reporting of laboratory and instrumental diagnostic examinations of a patient with Mitchellʼs syndrome, were used. Results. Neurological examination and paraclinical tests implied the patient had erythromelalgia, polyneuropathy (with vegetative-trophic and sensitive disorders, as well as movement disorders in the limbs, mainly in the distal parts), and erythremia. The use of complex therapy (gabapentin, L-lysine escinate, keltican, propranolol, suprastin, alerzin, methotrexate, acetylsalicylic acid) made it possible to improve the patientʼs condition. Conclusions. Erythromelalgia is a severe disease with high resistance to existent pharmacological approaches and unfavorable outcome. Although the modern drugs make it possible to reduce the subjective severity of symptoms, the frequency of paroxysms is hard to be controlled. Therefore, there is an urgent need to find new therapeutic approaches to the treatment of Mitchellʼs disease and the development of new methods that allow the detection of secondary forms of erythromelalgia.