Case Report: A 14-year old girl received her first dose of quadrivalent human papillomavirus vaccine
in the right deltoid muscle. Within 24 hours she developed severe pain, swelling,
numbness, and coldness of the right arm and hand. Diagnostics with ultrasound, nerve
conduction, and sensory evoked potentials were normal. The MRI scan of the right arm
and brachial plexus showed no nerve injury. The symptoms improved under physical and
occupational therapy. After 2 month skin temperature was normal and swelling reduced.
However, pain and lack of function is ongoing.
Discussion: Complex regional pain syndrome (CRPS, formerly known as Sudeck dystrophie) may develop
following limb trauma, lesions of the peripheral or central nervous system or fractures.
Incidence ranges in adults from 5.46 to 26.2/100,000/y. In the pediatric population
it is even less common. Diagnosis is based on clinical criteria by the International
Association for the Study of Pain. The clinical triad includes autonomic, sensory,
and motor disturbances. Pathophysiological concepts discussed are neuroinflammation,
pathological regulation of the sympathetic nervous system and affection of the central
nervous system. Therapy includes early physical and occupational therapy.
CRPS after vaccination is described after immunization against rubella and hepatitis
B. Recently in literature there were first cases published of CRPS I after immunization
with Gardasil, suggesting a higher risk of developing this complication compared with
other vaccines.
Conclusion: CRPS normally develops after trauma, fractures or lesions of the central or peripheral
nervous system. However, immunization may also cause CRPS. Therefore, CRPS should
be considered in patients with typical symptoms after vaccination.
