Resolution of refractory symptoms of secondary erythermalgia with intermittent epidural bupivacaine

Background and Objectives: Erythermalgia is a rare disorder characterized b y erythema, edema, elevated skin temperature, and burning pain of the hands and/or feet. The etiology of primary erythermalgia is idiopathic while sec ondary erythermalgia is associated with autoimmune and rheumatologic factor s, Symptoms are typically refractory to medical management. We report the u se of epidural bupivacaine as a treatment option for secondary erythermalgi a. Case Report: A 28-year-old woman presented with secondary erythromelalgia t hat was characterized by severe pain, swelling, and erythema. Medical manag ement failed and a lumbar epidural dosed with bupivacaine was used. This re sulted in complete resolution of the patient's symptoms. Conclusion: Intermittent epidural bupivacaine may provide treatment of the refractory symptoms of secondary erythermalgia.