The Enigma of Neuralgia: A Diagnostic Odyssey

Background: Exanthematous fever with vasculitis and neuralgia is a rare but significant clinical entity. This case involves a 67 - year - old male with diabetes mellitus and hypertension presenting with fever, rash, and left trigeminal neuralgia. The diagnostic challenge lay in identifying systemic small vessel vasculitis in the context of chronic illness. Methods: A detailed clinical evaluation was performed alongside laboratory investigations, skin biopsy, and MRI imaging. Multidisciplinary consultation with dermatology, neurology, and rheumatology specialists guided the diagnostic and therapeutic approach. Results: Investigations revealed normocytic normochromic anaemia, thrombocytopenia, leukocytoclastic vasculitis on skin biopsy, and chronic small vessel ischemic changes on MRI. The patient was diagnosed with small vessel vasculitis and trigeminal neuralgia secondary to exanthematous fever. Treatment with corticosteroids, neuropathic pain management, and supportive care led to symptomatic improvement. Conclusions: This case underscores the importance of comprehensive diagnostic evaluation and multidisciplinary management in systemic illnesses presenting with vasculitis and neuralgia. Early intervention can prevent complications and improve outcomes.