Pyridoxine Toxicity Small Fiber Neuropathy With Dysautonomia: A Case Report.

Pyridoxine (vitamin B6) toxicity is a well-known cause of primary sensory, length-dependent, axonal polyneuropathy. Although sensory symptoms predominate, autonomic symptoms have also been reported in some cases. To date, there is no objective evidence of autonomic dysfunction reported in the literature. We present the case of a 41-year-old woman with 2 years of progressive burning pain, numbness, tingling, and weakness in a stocking-glove distribution who was found to have severe pyridoxine toxicity. Concurrent presence of large and small fiber nerve dysfunction was noted in the form of abnormal electromyography/nerve conduction study demonstrating a chronic sensory polyneuropathy and autonomic testing demonstrating abnormal responses to quantitative sweat testing and cardiovagal function testing. This case highlights the need for consideration of small fiber nerve damage by obtaining autonomic testing in cases of pyridoxine toxicity.

Atorvastatin as novel treatment for neuropathic pain: a case report.

INTRODUCTION: Managing neuropathic pain can be very challenging, with standard medical therapies often providing inadequate relief. It has recently been reported in the literature that statins alleviate neuropathic pain in the rat model. We present a case report in which an above-the-knee amputee achieved relief of his neuropathic stump pain with atorvastatin. CASE REPORT: We describe the case of a 50-year-old man with a 12-year history of chronic neuropathic stump pain and sporadic phantom limb pain following an above-the-knee amputation. For 11 years the pain was managed with gabapentin 300 mg 3 times daily plus oxycodone 10 mg twice daily. He autonomously weaned himself to gabapentin 300 mg once daily and oxycodone 10 mg once daily, exacerbating his stump pain in the process. After starting atorvastatin 20 mg once daily for hypercholesterolemia, he immediately experienced decreased intensity of his stump pain, but his phantom pain persisted at its usual intensity. CONCLUSIONS: More studies are needed to characterize the analgesic effects of statins better. In patients who have neuropathic pain refractory to traditional treatment options or, rather, decline traditional treatment options, statin therapy may be helpful.