Recurrent and migratory reflex sympathetic dystrophy in children.

Reflex sympathetic dystrophy is a syndrome characterized by superficial pain and tenderness associated with swelling, vasomotor instability, and dystrophic changes of the skin. In children, it is rarely reported and is felt to have a more benign and self-limited course. This case illustrates that, in children, reflex sympathetic dystrophy can occur without any previous history of trauma, and may be recurrent and migratory. A review of the literature is included. An 11-year-old girl, with no history of trauma, presented in 1992 with spontaneous onset of right leg pain. She was diagnosed with reflex sympathetic dystrophy, and she was treated unsuccessfully with oral medications. Her symptoms then resolved in 2 weeks after receiving epidural anaesthesia and aggressive physical therapy. Over the next 5 years, she presented to the paediatric rehabilitation clinic three times with recurrent RSD in her bilateral arms. The first two times were refractory to conservative management and resolved with four stellate ganglion blocks. The third recurrence persisted with three stellate ganglion blocks and resolved with gabapentin.