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Sneddon's syndrome presenting with neuropathic pain.
[sneddon syndrome]
A
55
-
year
-old
man
was
admitted
to
us
with
a
sense
of
numbness
,
tingling
,
and
burning
in
his
feet
and
headache
,
characterized
as
a
feeling
of
pressure
all
around
his
head
,
for
1
year
and
aggravated
in
the
past
3
months
.
The
patient
's
neurologic
examination
was
normal
and
he
had
no
other
known
diseases
except
for
hypertension
according
to
his
medical
history
.
During
the
examination
,
we
recognized
purplish
lesions
on
the
patient
's
body
.
His
kidney
,
liver
,
and
thyroid
function
test
results
and
vitamin
B
12
levels
were
all
normal
.
His
hematocrit
level
was
41
.
8
%
,
platelet
value
was
234
,
000
(
150
,
000
-
500
,
000
)
;
and
sedimentation
rate
was
9
mm
/
h
(
0
-
20
)
.
Electromyography
was
performed
and
results
were
found
to
be
normal
.
The
patient
was
diagnosed
as
having
small
fiber
neuropathy
.
Dermatologic
examination
revealed
reddish
blue
mottling
of
the
skin
with
fishnet
reticular
pattern
on
his
back
,
on
the
front
side
of
the
body
,
and
on
both
arms
and
legs
,
and
the
lesions
were
classified
as
livedo
racemosa
(
Figure
1
)
.
Brain
magnetic
resonance
imaging
(
MRI
)
showed
subcortical
hyperintense
ischemic-gliotic
signal
changes
on
T
2
-
FLAIR
in
the
deep
white
matter
of
bilateral
frontoparietal
vertex
,
centrum
semiovale
,
and
corona
radiata
(
Figure
2
)
.
FLAIR
sequence
axial
MRI
of
the
brain
of
our
patient
showed
subcortical
hyperintense
lesions
in
both
cerebral
hemispheres
.
His
cardiac
examination
was
normal
and
minimal
aortic
regurgitation
was
seen
on
echocardiography
.
His
cognitive
assessment
Minimental
Test
Score
was
22
,
and
Montreal
Cognitive
Assessment
score
was
18
.
Laboratory
values
for
inflammatory
markers
and
autoimmune
antibodies
including
syphilis
serology
,
lupus
anticoagulants
,
and
anticardiolipin
antibodies
were
negative
.
Factor
V
Leiden
mutation
was
not
detected
in
the
patient
.
The
patient
was
diagnosed
with
Sneddon
's
syndrome
with
the
above
signs
and
symptoms
and
small
fiber
neuropathy
.
Clopidogrel
75
mg
and
gabapentin
1200
mg
was
started
once
a
day
and
blood
pressure
regulation
was
achieved
.
Diseases
Validation
Diseases presenting
"inflammatory markers"
symptom
acute rheumatic fever
dystrophic epidermolysis bullosa
erdheim-chester disease
inclusion body myositis
krabbe disease
legionellosis
malignant atrophic papulosis
pyomyositis
scrub typhus
sneddon syndrome
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