REFLEX SYMPATHETIC DYSTROPHY WITH MUTILATING ULCERATIONS SUSPICIOUS OF A FACTITIAL ORIGIN

Reflex sympathetic dystrophy (RSD) is a poorly understood posttraumati c pain syndrome associated with dysfunction of the sympathetic nervous system. Pain is often out of proportion to the extent of injury. Prog ression of the disease may lead to dystrophic and atrophic changes res ulting in total disability of an affected limb. Skin findings are high ly variable and nonspecific and may rarely include bullae and ulcerati ons. We describe a mutilating case of RSD with unusual and severely di sfiguring ulcerations that necessitated amputation of the right arm. S hortly after the amputation, ulcerations began appearing on the left a rm. We suspect a factitial component but have been unable to prove or disprove it. We propose that some ulcerations in patients with RSD may be factitial in origin.