一例伴有关节过度活动型埃勒斯-当洛综合征和肥大细胞活化综合征的复杂性区域疼痛综合征:非常规治疗的作用
A Case of Complex Regional Pain Syndrome With Hypermobile Ehlers-Danlos Syndrome and Mast Cell Activation Syndrome: The Role of Unconventional Therapies.
作者信息
Shabbir Zian, Mazdeyasnan Layla, McLain Mary
机构信息
Research, California Health Sciences University - College of Osteopathic Medicine, Clovis, USA.
Central Valley Indian Health, Community Medical Center, Fresno, USA.
出版信息
Cureus. 2025 Jul 14;17(7):e87898. doi: 10.7759/cureus.87898. eCollection 2025 Jul.
Complex regional pain syndrome (CRPS) type 2 is a chronic pain condition that develops after a nerve injury and is characterized by severe pain, allodynia, and functional impairments. Ehlers-Danlos syndrome hypermobility type (hEDS) and mast cell activation syndrome (MCAS) are connective tissue and inflammatory disorders that may contribute to the development of CRPS. Despite various treatment approaches, effective pain management remains a challenge, particularly in complex cases involving underlying genetic predispositions. We report the case of a 42-year-old female with a history of CRPS type 2, who was recently diagnosed with hEDS and had a family history of MCAS. Her clinical symptoms of chronic pain and gastrointestinal (GI) disturbances were unresponsive to typical therapeutic interventions. She was being managed with multiple medications. With this thought in mind, montelukast, a leukotriene receptor antagonist, was introduced, and the patient reported an initial improvement in pain. Cromolyn sodium, a mast cell stabilizer, was also added to her treatment regimen to further target her pain exacerbation. Finally, an anti-inflammatory focused GI regimen including betaine HCl, quercetin with bromelain, and other digestive enzymes was trialed. Her progress was monitored using a pain scale over the next six months. However, due to declining health, a subjective narrative scoring system replaced the Visual Analog Scale to represent her fluctuating and multifaceted symptom experience better. The relationship between hEDS, MCAS, and CRPS suggests a multifactorial pathogenesis involving connective tissue fragility, mast cell dysregulation, and neurogenic inflammation. Montelukast, cromolyn sodium, and GI supplementation represent potential therapeutic interventions for managing patients with CRPS linked to MCAS. These treatments offer a novel approach by targeting mast cell-mediated inflammation. This case emphasizes the need for further research into the role of mast cell stabilization in CRPS treatment to improve patient outcomes.
2型复杂性区域疼痛综合征(CRPS)是一种在神经损伤后发生的慢性疼痛病症,其特征为严重疼痛、痛觉过敏和功能障碍。埃勒斯-当洛综合征高活动型(hEDS)和肥大细胞活化综合征(MCAS)是结缔组织和炎症性疾病,可能促使CRPS的发生。尽管有各种治疗方法,但有效的疼痛管理仍然是一项挑战,尤其是在涉及潜在遗传易感性的复杂病例中。我们报告了一例42岁患有2型CRPS病史的女性病例,她最近被诊断出患有hEDS,且有MCAS家族史。她的慢性疼痛和胃肠道紊乱的临床症状对典型治疗干预无反应。她正在使用多种药物进行治疗。考虑到这一点,引入了白三烯受体拮抗剂孟鲁司特,患者报告疼痛最初有所改善。还在她的治疗方案中添加了肥大细胞稳定剂色甘酸钠,以进一步针对她的疼痛加剧情况。最后,尝试了一种以抗炎为重点的胃肠道方案,包括盐酸甜菜碱、含菠萝蛋白酶的槲皮素和其他消化酶。在接下来的六个月里,使用疼痛量表监测她的进展。然而,由于健康状况下降,一种主观叙述评分系统取代了视觉模拟量表,以更好地体现她波动且多方面的症状体验。hEDS、MCAS和CRPS之间的关系表明其发病机制是多因素的,涉及结缔组织脆弱性、肥大细胞失调和神经源性炎症。孟鲁司特、色甘酸钠和胃肠道补充剂是治疗与MCAS相关的CRPS患者的潜在治疗干预措施。这些治疗方法通过针对肥大细胞介导的炎症提供了一种新方法。该病例强调需要进一步研究肥大细胞稳定在CRPS治疗中的作用,以改善患者预后。
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