Case 2: A Young Woman with Numbness and Tingling in Both Hands

Presenter: Adam Fleisher, MD Mentor: Vinay Chaudry, MD

Disclosures

March 18, 2002

In This Article

Case Presentation

A 29-year-old, right handed, East Indian woman presented with worsening numbness and tingling in both hands.

History

The patient's symptoms began about 2 years before hospital admission, when she noted discoloration of the skin on her feet. She first noticed the rash on the top medial aspect of her left foot. A few months later, she saw a similar discoloration on the top of her right foot. She was not aware of any numbness in that region and did not pay further attention to this.

Toward the beginning of her pregnancy in 1998, she became aware of tingling sensations in the fingertips of her left hand. After her pregnancy, however, these symptoms resolved. From the end of December 1999 to the beginning of January 2000, she began to experience more frequent tingling sensations in the index and middle fingers of her left hand. This gradually progressed to include all the digits of the left hand.

During this time, she also noticed a blister on her left index finger and the left middle finger, but she assumed this was the result of a burn she might have sustained, unawares, while cooking or ironing. She also noticed that she was dropping objects held in the left hand.

At this time, she sought medical attention from her internist who thought this could be arthritis and who prescribed celecoxib.

The patient traveled to India on January 26, 2000. This was the first visit to India she had made in 12 years. The tingling sensation in her left hand had become continuous and now she began to feel more numbness as well. She saw a dermatologist and a neurologist in India who examined her and the discolored patches on her feet and found them to be numb.

She underwent a skin biopsy to look for evidence of vascular or infectious changes. She was told that the skin biopsy was negative, but was prescribed antibiotics for a presumed bacterial infection.

Within days after starting the antibiotics, she began experiencing severe pain, primarily in the left shoulder and extending to the entire left arm. She also experienced further discoloration and rash on multiple areas on her body, including patches on her right foot extending to the right ankle, the left foot now extending more medially, the right side of her face, and several areas on her back. She was unaware that these areas were particularly numb.

Along with the worsening pain, she also developed numbness her right hand, more medially side (the little finger and the ring finger). During this time, she also developed daily fevers to 100-101° F (38.3-38.8° C) and felt extremely tired with very poor appetite, losing 15-16 lbs. during this time.

These symptoms continued for approximately 6 weeks, until her return to the United States on March 30. Since then, her fever has subsided and the pain is virtually gone in her shoulder region. Even the skin rashes have subsided with the corticosteroid cream given by her dermatologist in the United States.

Current Symptoms

Presently, the patient's major symptoms are numbness and tingling in both hands, on the left side more than the right, and weakness in her left hand. She does not have particular symptoms in the lower extremities.

She feels that the numbness and the weakness have not progressed in the last 3 months since her return to the United States. She was seen by a dermatologist here who took another skin biopsy from the back, who found no abnormalities and discontinued her antibiotic for about 15 days. Her pain and tingling subsided somewhat, but the dermatologist was not clear about the diagnosis so restarted her on these medications.

Previous Medical History

The patient is the mother of a healthy 2-year-old son. She has been diagnosed with adult-onset reactive airway disease, treated intermittently with inhalers during the winter months. She has a congenital extra distal phalanx on her left thumb and congenital hip dislocation from a breech birth. Before traveling to India, she had received hepatitis B and Bacillus Calmette-Guerin (BCG) vaccines.

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