Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202200952
Jornal Vascular Brasileiro
Case Report

Endoscopic lumbar sympathectomy as a treatment option for primary erythromelalgia - case report and review

Simpatectomia lombar endoscópica como escolha de tratamento para eritromelalgia primária - relato de caso e revisão

Marcelo de Paula Loureiro; Pietro Maran Novais; João Augusto Nocera Paulin; Daniel Benzecry de Almeida; Arlindo Nascimento de Lemos Junior

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Abstract

Abstract: Erythromelalgia is a rare disease, involving pain, edema, redness, and hyperthermia in the limbs. It is extremely refractory to drugs, has no defined treatment, and causes psychological comorbidities in the patient. We describe a case of erythromelalgia involving a 17-year-old boy who had been suffering from the disease for almost 4 years prior to finding an effective treatment. A bilateral endoscopic lumbar sympathectomy was performed, limited to L2 and L3 resections. Four weeks after the procedure, the patient’s symptoms were significantly mitigated and at 8 months follow-up he remained almost asymptomatic. Endoscopic lumbar sympathectomy was an effective treatment for primary erythromelalgia in this teenager, with exceptional reduction of his symptoms.

Keywords

lumbar sympathectomy, primary erythromelalgia, teenager, surgery, treatment

Resumo

Resumo: Eritromelalgia é uma doença rara caracterizada por dor, edema, eritema e hipertermia nos membros. É extremamente refratária a medicamentos e não tem um tratamento definido, causando comorbidades psicológicas para o paciente. Descrevemos o caso de um menino de 17 anos que possuía eritromelalgia há quase 4 anos antes de ser submetido a um tratamento efetivo. Foi realizada simpatectomia lombar endoscópica bilateral limitada à ressecção dos gânglios L2 e L3. Após 4 semanas do procedimento, o paciente teve diminuição significativa dos seus sintomas e, com 8 meses de seguimento, permanece praticamente assintomático. A simpatectomia lombar endoscópica foi um tratamento eficaz para eritromelalgia primária em um adolescente, com redução excepcional dos seus sintomas.
 

Palavras-chave

simpatectomia lombar, eritromelalgia primária, adolescente, cirurgia, tratamento

References

1 Fleck DE, Hoeltzel MF. Hand and foot color change: diagnosis and management. Pediatr Rev. 2017;38(11):511-9. http://dx.doi.org/10.1542/pir.2016-0234. PMid:29093119.

2 Belch JJF. Temperature-associated vascular disorders: Raynaud’s phenomenon and erythromelalgia. In: Tooke JE, Lowe GDO, editors. A textbook of vascular medicine. London: Arnold; 1996. p. 329-51.

3 Leroux MB. Erythromelalgia: a cutaneous manifestation of neuropathy? An Bras Dermatol. 2018;93(1):86-94. http://dx.doi.org/10.1590/abd1806-4841.20187535. PMid:29641704.

4 Cohen JS. Erythromelalgia: new theories and new therapies. J Am Acad Dermatol. 2000;43(5):841-7. http://dx.doi.org/10.1067/mjd.2000.109301. PMid:11050591.

5 Cook-Norris RH, Tollefson MM, Cruz-Inigo AE, Sandroni P, Davis MD, Davis DM. Pediatric erythromelalgia: a retrospective review of 32 cases evaluated at Mayo Clinic over a 37-year period. J Am Acad Dermatol. 2012;66(3):416-23. http://dx.doi.org/10.1016/j.jaad.2011.01.010. PMid:21798623.

6 Kundu A, Rafiq M, Warren P, Tobias J. Erythromelalgia in the pediatric patient: role of computed-tomography-guided lumbar sympathetic blockade. J Pain Res. 2016;9:837-45. http://dx.doi.org/10.2147/JPR.S110688. PMid:27799815.

7 Kalgaard OM, Seem E, Kvernebo K. Erythromelalgia: a clinical study of 87 cases. J Intern Med. 1997;242(3):191-7. http://dx.doi.org/10.1046/j.1365-2796.1997.00185.x. PMid:9350163.

8 Bang YJ, Yeo JS, Kim SO, Park YH. Sympathetic block for treating primary erythromelalgia. Korean J Pain. 2010;23(1):55-9. http://dx.doi.org/10.3344/kjp.2010.23.1.55. PMid:20552075.

9 Pekař M, Mazur M, Pekařová A, Kozák J, Foltys A. Lumbálna sympatektómia − prehľad svetovej literatúry za posledných 15 rokov. Rozhl Chir. 2016;95(3):101-6. PMid:27091617.

10 Loureiro MD, Roman N, Weigmann SC, Fontana A, Boscardim PC. Simpactectomia lombar retroperitoneoscópica para tratamento da hiper-hidrose plantar. Rev Col Bras Cir. 2007;34(4):222-4. http://dx.doi.org/10.1590/S0100-69912007000400005.

11 Loureiro MD, Campos JR, Kauffman P, Jatene FB, Weigmann S, Fontana A. Endoscopic lumbar sympathectomy for women: effect on compensatory sweat. Clinics. 2008;63(2):189-96. http://dx.doi.org/10.1590/S1807-59322008000200006. PMid:18438572.

12 Loureiro MD, Reisfeld R, Basseri E, Nishi GK, Rieger R, Wurm-Wolfsgruber K. Hyperhidrosis: a complete guide to diagnosis and management. Cham: Springer; 2018. Endoscopic lumbar sympathectomy in the treatment of hyperhidrosis: results and complications. p. 215-24. http://dx.doi.org/10.1007/978-3-319-89527-7_28.

13 Chakova M, Chernev D, Kashukeeva P, Krustev P, Abedinov F. Lumbar sympathectomy - literature review. Int J Sci Res. 2018;7(8):1183-4.

14 Beglaibter N, Berlatzky Y, Zamir O, Spira RM, Freund HR. Retroperitoneoscopic lumbar sympathectomy. J Vasc Surg. 2002;35(4):815-7. http://dx.doi.org/10.1067/mva.2002.121130. PMid:11932687.

15 Postlethwaite JC. Lumbar sympathectomy a retrospective study of 142 operations on 100 patients. Br J Surg. 1973;60(11):878-9. http://dx.doi.org/10.1002/bjs.1800601111. PMid:4752732.

16 Hashmonai M, Cameron AE, Licht PB, Hensman C, Schick CH. Thoracic sympathectomy: a review of current indications. Surg Endosc. 2016;30(4):1255-69. http://dx.doi.org/10.1007/s00464-015-4353-0. PMid:26123342.

17 Wang WH, Zhang L, Dong GX, et al. Chemical lumbar sympathectomy in the treatment of recalcitrant erythromelalgia. J Vasc Surg. 2018;68(6):1897-905. http://dx.doi.org/10.1016/j.jvs.2018.05.226. PMid:30126782.

18 Shiga T, Sakamoto A, Koizumi K, Ogawa R. Endoscopic thoracic sympathectomy for primary erythromelalgia in the upper extremities. Anesth Analg. 1999;88(4):865-6. PMid:10195539.

19 Nakajima Y, Koizumi K, Hirata T, Hirai K, Sakamoto A, Shimizu K. Successful thoracoscopic sympathectomy for primary erythromelalgia in the upper extremities. Jpn J Thorac Cardiovasc Surg. 2004;52(11):524-6. http://dx.doi.org/10.1007/s11748-004-0003-5. PMid:15609644.
 


Submitted date:
09/22/2022

Accepted date:
11/16/2022

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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