RSD Puzzle #020

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

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BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

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RSD PUZZLE #20
Unexplained Temperature Changes

"I have had RSD for the past 6 years. In the past 1 year, I have been suffering from bouts of fever and skin rash. They don't necessarily happen in the same time. Every time I have a menstrual period, my temperature jumps to 100º to 101º. At other times, in the absence of any kind of infection, my temperature jumps up to 104º to 105º. The blood cultures have been negative and antibiotics do not help. The high temperature lasts one to two days and then it clears up".

Attacks of fever are not unusual in late stage (stages III and IV) of RSD. One of the major functions of the sympathetic system has been influencing and stimulating the immune system.

Years of inflammation of soft tissues due to RSD result in disturbance of function of the immune system. As a result the patient may develop a precipitous drop in platelet cell count, a rise in the white blood cell count, bouts of low or high-grade fever.

Whereas in the first few years the RSD patients have less tendency to suffer from viral infections and upper respiratory tract infections due to contamination from the other members of the family, in stages III and IV of RSD, the reverse is true. The late stage RSD patients are more likely to develop viral or upper respiratory tract infections.

The phenomenon of "aseptic fever" due to the disturbance of the immune system in absence of any type of infection is nothing but the disturbance of the function of the immune system and the manifestation of inflammation secondary to RSD. Such bouts of fever usually subside with effective treatment for RSD such as administration of infusion pump.

In the late stages of RSD, the sympathetic ganglion nerve blocks usually are not effective but the treatment with oral or skin patch alpha blockers can help control the bouts of aseptic fever.

H. Hooshmand, M.D.

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