A refractory case of secondary erythermalgia successfully treated with lumbar sympathetic ganglion block

A 59-year-old Japanese man with myasthenia gravis, who had a 10-year histor y of temperature-sensitive pain in the lower extremities, i.e. improved by cooling and worsened by warming, consulted us because the pain had become i ntolerable during the previous 4 months. Bilateral erythema, swelling and l arge ulcers were noted on the calves, dorsal aspects of the feet, and soles . Laboratory data showed thrombocythaemia and a positive antibody to the ac etylcholine receptor, but were negative for antinuclear and antiphospholipi d antibodies. A diagnosis of secondary erythermalgia was made because of th e clinical features, the laboratory data, and the lack of family history of this disease. Although steroid pulse therapy, oral aspirin and antiseroton in drugs were ineffective, bilateral lumbar sympathetic ganglion block succ eeded in relieving the severe pain and curing the ulcers. The clinical cour se in our patient suggests that sympathetic ganglion block may be one of th e most effective treatments for secondary erythermalgia. Although the mecha nism of this effect is uncertain, microcirculation disturbance in secondary erythermalgia, if any, may be improved by this block.