SHM Converge Scientific Abstract ePoster Gallery-Complex Regional Pain Syndrome Masking Metastatic Epithelioid Hemangioendothelioma: A Diagnostic Challenge and Clinical Dilemma

Complex Regional Pain Syndrome Masking Metastatic Epithelioid Hemangioendothelioma: A Diagnostic Challenge and Clinical Dilemma

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This case report describes a 62-year-old woman whose worsening right arm pain and swelling were initially attributed to complex regional pain syndrome (CRPS) after carpal tunnel surgery. CRPS is a diagnosis of exclusion, and the Budapest Criteria require clinicians to rule out other causes of symptoms. Despite treatment with antibiotics, nerve blocks, physical therapy, opioids, neuromodulators, and even lidocaine infusion, her condition continued to deteriorate.<br /><br />On examination, she had marked swelling, erythema, and tenderness from the fingers to the distal arm, with no active motion in the fingers, wrist, or elbow. Labs showed leukocytosis, anemia, and thrombocytosis. MRI suggested cellulitis, myositis, synovitis, and marrow edema. Multiple specialties were consulted, and joint aspiration was negative for infection. Because her course was unusual and progressive, a forearm biopsy was eventually performed.<br /><br />The biopsy revealed epithelioid hemangioendothelioma (EHE), a rare and aggressive vascular tumor that can mimic inflammatory or musculoskeletal disorders. In this patient, the diagnosis came late, after a year of presumed CRPS, and by then the disease had already metastasized to the lungs and liver. She underwent right glenohumeral disarticulation with axillary lymph node dissection, followed by rehabilitation and oncology follow-up, but died about one month later.<br /><br />The report emphasizes that atypical or refractory CRPS-like presentations should prompt renewed investigation, including early imaging and biopsy when warranted. Maintaining a broad differential diagnosis and using a multidisciplinary approach are essential to avoid diagnostic delay, especially for rare malignancies such as EHE.

Asset Subtitle

Philicia Duncan

Meta Tag

Author List Philicia Duncan

Category Clinical Vignettes

Concept Complex Regional Pain Syndrome

Concept Epithelioid Hemangioendothelioma

Concept Diagnosis of Exclusion

Concept Budapest Criteria

Concept Imaging

Distinguished Non-Finalist

Presenter Organization The Ohio State University Wexner Medical Center

Presenting Author Philicia Duncan

Track Adult

Keywords

complex regional pain syndrome

CRPS

epithelioid hemangioendothelioma

vascular tumor

right arm pain

diagnosis of exclusion

forearm biopsy

metastatic disease

carpal tunnel surgery

multidisciplinary diagnosis

Complex Regional Pain Syndrome

Epithelioid Hemangioendothelioma

Diagnosis of Exclusion

Budapest Criteria

Imaging