POSSIBLE ERYTHROMELALGIA-LIKE SYNDROME-ASSOCIATED WITH NIFEDIPINE IN A PATIENT WITH RAYNAUDS-PHENOMENON

OBJECTIVE: To describe a patient who was diagnosed with Raynaud's phen omenon, was prescribed immediate-release nifedipine, and developed a p ossible erythromelalgia-like syndrome. CASE SUMMARY: A 24-year-old whi te woman with a history of esophageal spasms and Raynaud's phenomenon was prescribed nifedipine 10 mg po qid. Approximately 1 hour after the patient had taken the fourth dose of nifedipine, she experienced acut e erythema and a burning sensation in her feet and lower limbs, light- headedness, and palpitations. Because of a reportedly abnormally low b lood pressure, the patient took diphenhydramine 50 mg po and proceeded to the clinic. On arrival, abnormal vital signs were BP 140/48 mm Hg and HR 130 beats/min. Without any other medical intervention, approxim ately 30 minutes later her blood pressure and heart rate had returned to baseline at 122/60 mm Hg and 96 beats/min, respectively. The nifedi pine was permanently discontinued and the patient's symptoms completel y resolved over 24 hours. DISCUSSION: The characteristic symptoms of e rythromelalgia include burning pain, increased skin temperature, and e rythema of the extremities, usually to the feet, lower legs, and, less often, the hands. Erythromelalgia-like syndromes secondary to the adm inistration of many medications have been reported. Several nifedipine -related reports describe an erythromelalgia-like syndrome similar to our reported case. CONCLUSIONS: Because the patient was not taking any other medications and the symptoms started with the administration of nifedipine and were relieved after its discontinuation, nifedipine wa s thought to be the cause of the erythromelalgia-like syndrome.