Leriche Syndrome Misdiagnosed as Complex Regional Pain Syndrome in a Patient with Neuropathic Pain Caused by a Chip Fracture: A Case Report

Abstract

Introduction: Leriche syndrome is an aortoiliac occlusive disease caused by atherosclerotic occlusion. We report a case of Leriche syndrome with a fracture that was suspected as complex regional pain syndrome (CRPS), as the post-traumatic pain gradually worsened in the form of excruciating neuropathic pain. Case Report: A 52-year-old woman with a history of hypertension was referred to the Department of Pain Medicine from a local orthopedic clinic because of suspected CRPS for excruciating neuropathic pain for one month. She complained of gait dysfunction and severe pain in the right foot following an incident of trauma with the right first toe. The average pain intensity assessed using the visual analog scale (VAS) was 90 (0: no pain, 100: the worst pain imaginable), and the neuropathic pain was evident as a score of 6/10 on Douleur neuropathique 4. Allodynia, hyperalgesia, blue discoloration of the skin, asymmetric temperature change (1.38 °C), and edematous soft tissue changes were observed. Ultrasonography showed a chip fracture in the first distal phalanx of the right first toe. The diagnosis was most probably CRPS type I according to the Budapest research criteria for CRPS. However, multiple pain management techniques were insufficient in controlling the symptoms. A month and a half later, an ankle-brachial index score of less than 0.4 suggested severe peripheral artery disease. Computed tomography angiography showed total occlusion between the infrarenal abdominal aorta and the bilateral common iliac arteries. Therefore, she underwent aortic-bifemoral bypass surgery with a diagnosis of Leriche syndrome. Three months after the surgery, the average pain intensity was graded as 10 on the VAS (0–100), the color of the skin of the right first toe improved and no gait dysfunction was observed. Conclusion: A chip fracture in a region with insufficient blood flow could manifest as excruciating neuropathic pain in Leriche syndrome.

Leriche syndrome diagnosed due to polytrauma: a case report

“…Several cases of Leriche syndrome have been discovered after surgery or isolated trauma; however, those discovered after multiple traumatic injuries are very rare. To the best of our knowledge, this is the first report of Leriche syndrome discovered in a patient with multiple traumatic injuries [6,7].…”

Aortoiliac Occlusion in a Rare Instance of Leriche Syndrome Type I in a 65-Year-Old Woman With Chronic Leg Discomfort Refractory to Pregabalin

“…Neurogenic abnormalities have been shown in a very small number of studies to be a presenting symptom for Leriche syndrome as well [9]. Leriche syndrome can thus delay diagnosis by mimicking relatively benign diseases like sciatica and complex regional pain syndrome [10,11]. Moreover, according to the previous literature, Leriche syndrome is often diagnosed in patients with severe comorbidities such as a history of myocardial infarction, acute pulmonary embolism, dilated cardiomyopathy, and heart failure with reduced ejection fraction [12,13].…”

El Síndrome de Leriche: Subdiagnóstico en la Enfermedad Arterial Periférica

“…La claudicación es el dolor en las piernas tipo calambres, que es reproducible con la actividad física, a causa de la deuda de oxígeno por la oclusión arterial, existiendo una inadecuada satisfacción de las demandas metabólicas de las extremidades. Los pacientes con claudicación también pueden presentar dolor nociceptivo; mientras que, aquellos que presenten isquemia crítica distal, desarrollarían dolor neuropático 11 .…”