Article

We present the complex case of a 49-year-old woman who worked as a cook in a
school cafeteria and has been suffering from widespread pain since 2002. This
patient showed a very particular gait pattern with hips adduction, flexed hips
and knees and bilateral equinus foot deformity. Clinical examinations conducted
by various clinicians, such as physical medicine and rehabilitation (PM&R)
physicians and neurologists, yielded very different diagnostic hypotheses, each
being nevertheless quite "logical": fibromyalgia syndrome with dystonia, CNS
injury, Little's disease, intramedullary spinal cord tumor or multiple sclerosis.
The only abnormalities observed occurred during the quantitative sensory test
presenting as severe widespread allodynia to cold and hot temperatures and during
Laser Evoked Potentials shown as a dysfunctional pattern for central processing
of nociceptive data. Gait analysis showed that parameters were in the norms.
Considering these different tests and the excellent progression of the patient's
gait and general posture, we must envision that the fibromyalgia syndrome
hypothesis remained the most likely one. The generalized dystonia was probably
due to the patient's analgesic protective attitude. The actual therapy is still
based on the biopsychosocial approach.
CI - Copyright (c) 2011 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS ; FRANCAIS