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Acute steroid responsive small-fiber sensory neuropathy: a new entity?

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Small-fiber neuropathy is often idiopathic and commonly follows a chronic course. Treatment is often effective in treating the core symptom of pain, but it has no effect on the pathologic process. We describe four patients with acute small-fiber neuropathy who responded dramatically to steroid therapy. All patients had acute onset neuropathic pain, normal nerve conduction studies, and evidence of small-fiber dysfunction in quantitative sensory testing and skin biopsy. Symptoms were distal and symmetrical in three patients and generalized in one patient. In two cases, the neuropathy presented as an erythromelalgia-like syndrome. Marked clinical improvement occurred 1–2 weeks after oral prednisone therapy was initiated. Three patients remained symptom free, and one patient experienced recurrence of neuropathy after prednisone was tapered.
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Keywords: erythromelalgia; neuropathic pain; quantitative sensory testing; small-nerve fiber neuropathy; steroids

Document Type: Research Article

Affiliations: 1: Department of Neurology; and 2: Pediatric Neurology Unit, Wolfson Medical Center, Holon, Israel; affiliated with The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel

Publication date: March 1, 2006

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