23rd Annual Pain Medicine Meeting 2024

Pruritic foot pain: an unusual presentation of neuropathy after COVID-19 infection

Allison Sadowski, DO

Oluwatosin Pelumi Ayotunde, MD

Roger Haddad, DO

INTRODUCTION

COVID-19 infections can cause significant neurologic complications including peripheral nerve damage and post-viral neuropathic pain.

METHODS

As the case report is devoid of patient identifiable information, it is exempt from IRB review requirements as per Henry Ford Health policy. Patient consent was obtained for publication and discussion of this case report.

CASE REPORT

Initial visit

57-year-old female with a past medical history of type 2 diabetes mellitus, chronic neck and low back pain presented with a chief complaint of left foot pain

Initial exam: diminished sensation to light touch in bilateral feet, no motor deficits and no structural deformities

Initial assessment and plan: diabetic neuropathy, start pregabalin and physical therapy

Follow-up visit

Minimal improvement, described worsening symptoms and “deep, painful itching” of the foot

One year later

Medications had been maximized without any meaningful relief

Differential diagnosis broadened to include tarsal tunnel syndrome and radicular pain

New plan: referred to podiatry, start desensitizing physical therapy and a muscle relaxer

Follow-up visit

No improvement

A new history was obtained and revealed that a COVID-19 infection immediately preceded the onset symptoms, and her “itching” was noted to be localized to the sensory distribution of the superficial peroneal and tibial nerves

A new etiology of peripheral neuropathy secondary to viral infection was considered

A superficial peroneal nerve block did not provide any relief

A left tibial nerve block resulted in complete resolution of pain and itching

23rd Annual Pain Medicine Meeting 2024

PRURITIC FOOT PAIN: AN UNUSUAL PRESENTATION OF NEUROPATHY AFTER COVID-19 INFECTION

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