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Complex Regional Pain Syndrome Following Snakebite: A Putatively Rare Complication of Envenomation and Review of the Literature

Authors Lazaro RP

Received 5 August 2020

Accepted for publication 28 October 2020

Published 10 November 2020 Volume 2020:13 Pages 603—607

DOI https://doi.org/10.2147/IMCRJ.S275591

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Ronald Prineas


Reynaldo P Lazaro

Neurology and Electromyography Clinic, Oneonta, NY 13820, USA

Correspondence: Reynaldo P Lazaro
Neurology and Electromyography Clinic, 41– 45 Dietz Street, Oneonta, NY 13820, USA
Tel +1 607 432-827
Fax +1 607 441-5051
Email RPL528@cs.com

Background: Complex regional pain syndrome (CRPS) following snakebite is considered rare. Only four cases have been reported in the world literature. The present case is the first in the United States. We felt the need to report this case to bring attention to health-care providers that CRPS is probably an under-recognized complication of snakebite.
Case Presentation: A 44-year-old right-handed man developed signs and symptoms of complex regional pain syndrome (CRPS) in the left upper extremity following a bite by a cat-eyed snake (genus Leptodeira), a slightly venomous snake that belongs to the Colubridae (colubrids) family. The man did not develop muscle weakness or hematologic complications at that time. However, in subsequent years, he developed sporadic jerking of the upper extremities without alteration in consciousness or electroencephalographic abnormalities. These movements tended to occur during emotional tension and exacerbation of pain, and decreased in frequency when the subject was distracted. This is the fifth case of snakebite-induced CRPS described in the world literature (Nepal, Turkey, Korea, and Norway), the first reported in the United States, and the first induced by a slightly venomous snake.
Conclusion: With closer attention to the presence of indicators of sympathetic nerve dysfunction in association with allodynia, it is probable that cases of persistent pain following snakebite might have been instances of CRPS.

Keywords: complex regional pain, snakebite, envenomation, myoclonus, movement disorder, neurotoxin, hemotoxin

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