NONTRAUMATIC COMPLEX REGIONAL PAIN SYNDROME IN A MALE WITH ADENOCARCINOMA OF THE LUNG: A CASE REPORT

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Complex Regional Pain Syndrome (CRPS) was first described in 1864 as painful hands and feet American soldiers during civil war who wrapped their wounded limbs rags to ameliorate symptoms. The Budapest criteria is often used diagnose CRPS includes at least one symptom all four categories (sensory, motor/trophic, vasomotor, sudomotor) sign two or more categories. syndrome affects females 80% of cases. Two types have been based on etiology - Type I precipitated by tissue injury type II known major nerve injury. Mechanisms underlying are still incompletely understood may result from aberrantly regenerated peripheral fibers, altered central pain mediating structures, variable expression neurotransmitters like Substance P the site There no gold standard test, however increased juxta-articular uptake involved joints 99mTc-MDP bone scans has suggestive CRPS. CASE PRESENTATION: 53 year old male former smoker presented Emergency department with worsening right upper extremity that started 4 months ago neck shoulder pain, later arm forearm progressing swelling, numbness temperature changes limb absence any history trauma. He also reported blurry vision, tearing redness eye. On examination, marked tenderness limb, reduced range motion shoulder, handgrip, ptosis miosis eye, nail clubbing, swelling discoloration hand breath sounds lobe. Workup ruled out rheumatological infectious etiology. Chest x ray revealed a lung mass, which diagnosed adenocarcinoma biopsy. DISCUSSION: Diagnosis made clinically sometimes supported ancillary tests such scan. However, diagnosis spontaneous can be missed precipitating cause. Therefore, there should not hesitancy diagnosing patients. Cases association Cerebral, Pancreatic, Ovarian Pancoast tumors. temporal relation between cancer onset clearly known. It represent paraneoplastic cancerous mass re-wiring nerves nervous system affecting perception various stimuli affected region. Further studies needed determine causal relationship malignancies pathogenesis. CONCLUSIONS: challenging, especially when it comes 10% cases unrelated possibility malignancy cannot excluded CRPS, pursued. REFERENCE #1: Ku A, Lachmann E, Tunkel R, Nagler W. Upper reflex sympathetic dystrophy associated occult malignancy. Arch Phys Med Rehabil. 1996;77(7):726-728. doi:10.1016/s0003-9993(96)90017-9 #2: Damle NA, Tripathi M, Singhal et al. Association non-traumatic complex regional Indian J Nucl Med. 2012;27(4):249-251. doi:10.4103/0972-3919.115397 #3: Pons T, Shipton EA, Williman J, Mulder RT. Potential risk factors for 1: systematic literature review. Anesthesiol Res Pract. 2015;2015:956539. doi:10.1155/2015/956539 DISCLOSURES: No relevant relationships Afsheen Afzal, source=Web Response Carolina Moreira Sarmiento,