Polycythemia vera presenting as complex regional pain syndrome of the lower limbs

Case Report: A 73-year-old woman with bilateral severe pain in her legs and feet was admitted to the hospital. The pain had started spontaneously with out any known trauma a year earlier and had progressively worsened to the p oint that she was unable to walk. The patient complained of pain, discolora tion. and sweating of the lower extremities. Physical examination revealed swollen. cold, wet, and blue extremities, with both allodynia and hyperalge sia, fulfilling criteria for a diagnosis of complex regional pain syndrome (CRPS) type I. Laboratory findings demonstrated a hemoglobin level of 180 g /L-1 and a hematocrit of 47%. leading to a diagnosis of polycythemia vera ( PCV). Her condition slowly improved after repeated venesection. mild analge sics, and amitriptyline. Conclusions: Polycythemia vera has not been described previously as a contr ibuting factor in CRPS. In the present case, the diagnosis of PCV was impor tant. because its treatment also improved the CRPS.