Itch is a common manifestation in systemic diseases such as malignancy, myeloproliferative disorders, uraemia, and allergy. Recent microneurography studies showed that itch is mediated by a distinct subset of C fibres, the ‘‘itch fibres’’, that are exclusively sensitive to histamine. We described the case of a 68-year-old woman complaining of itch at trunk and legs with acute onset three years before our first observation. Itching was induced by ambient warm and was associated with a persisting burning-like heat sensation. Extensive dermatologic and allergologic investigations were negative unrevealing. Treatment with anti-histaminergic and low-dosage oral steroids for 6 months did not modify the clinical picture. Physical examination was negative. Laboratory investigations revealed only neutrophilic leukocytosis, whereas chemistry profile, thyroid-stimulating hormone, serum and urine immunofixation, and screening for immunologic, infectious, and neoplastic disease was negative. Cerebrospinal fluid examination was normal. Gabapentin (1200 mg/day) reduced itch severity from 10 to 5 of the visual analogue scale (VAS) at 1-month follow-up. Nerve conduction study and needle electromyography was normal. Quantitative sensory testing in foot and distal leg disclosed warm hyperalgesia. Cutaneous blood flow by laser Doppler flowmetry at distal legs showed abnormal vasodilatation function induced by local heating. Skin biopsy demonstrated reduced intraepidermal nerve fibre density at the proximal thigh (8.7/mm) and normal value at the distal leg (7.8/mm) with diffuse axonal swellings. Total body CT-scan showed laterocervical and mediastinic lymphadenopathy. The histological exam of axillary lymph nodes revealed Tlymphocitic T-zone lymphoma (TZL). Itch is a common symptom in lynphoproliferative disease. In our case, the distinctive feature of itch, the histological impairment of small fibres and the success of treatment, suggest the presence of uncommon itching SFN.
Itching syndrome as manifestation of neuropathic pain - A case report
DEVIGILI, Grazia;TOLA, Maria Rosaria;TUGNOLI, Valeria;DE GENNARO, Riccardo;CASETTA, Ilaria;GRANIERI, Enrico Gavino Giuseppe
2006
Abstract
Itch is a common manifestation in systemic diseases such as malignancy, myeloproliferative disorders, uraemia, and allergy. Recent microneurography studies showed that itch is mediated by a distinct subset of C fibres, the ‘‘itch fibres’’, that are exclusively sensitive to histamine. We described the case of a 68-year-old woman complaining of itch at trunk and legs with acute onset three years before our first observation. Itching was induced by ambient warm and was associated with a persisting burning-like heat sensation. Extensive dermatologic and allergologic investigations were negative unrevealing. Treatment with anti-histaminergic and low-dosage oral steroids for 6 months did not modify the clinical picture. Physical examination was negative. Laboratory investigations revealed only neutrophilic leukocytosis, whereas chemistry profile, thyroid-stimulating hormone, serum and urine immunofixation, and screening for immunologic, infectious, and neoplastic disease was negative. Cerebrospinal fluid examination was normal. Gabapentin (1200 mg/day) reduced itch severity from 10 to 5 of the visual analogue scale (VAS) at 1-month follow-up. Nerve conduction study and needle electromyography was normal. Quantitative sensory testing in foot and distal leg disclosed warm hyperalgesia. Cutaneous blood flow by laser Doppler flowmetry at distal legs showed abnormal vasodilatation function induced by local heating. Skin biopsy demonstrated reduced intraepidermal nerve fibre density at the proximal thigh (8.7/mm) and normal value at the distal leg (7.8/mm) with diffuse axonal swellings. Total body CT-scan showed laterocervical and mediastinic lymphadenopathy. The histological exam of axillary lymph nodes revealed Tlymphocitic T-zone lymphoma (TZL). Itch is a common symptom in lynphoproliferative disease. In our case, the distinctive feature of itch, the histological impairment of small fibres and the success of treatment, suggest the presence of uncommon itching SFN.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
