ABSTRACT
Trigeminal trophic syndrome (TTS) is a rare neurological condition characterized by self-induced injury to the face in the distribution of the trigeminal nerve. Chronic scratching or picking cause ulceration, scarring, and tissue loss. TTS typically occurs following damage to the trigeminal nerve, often from surgical procedures, trauma, or stroke. We present a case of trigeminal trophic syndrome in an elderly lady who successfully responded to oral N-acetylcysteine. An increased awareness of this rare syndrome and potential treatment options will encourage a prompt diagnosis and possibly prevent permanent disfiguration.
ABSTRACT
A 67-year-old morbidly obese female with a background of stage 4 chronic renal failure, ischaemic heart disease, congestive cardiac failure, atrial fibrillation and type 2 diabetes mellitus presented with sepsis and necrotic lesions of the proximal lower limbs. Initial histological findings were consistent with the clinical diagnosis of calciphylaxis and supportive treatment was commenced with addition of a phosphate binder and dietary restriction. Due to high anaesthetic risk, her wounds were managed with larva therapy in the first instance, however, ultimately surgical debridement was the required. Repeat histology from a further biopsy revealed necrosis secondary to numerous thrombi in the cutaneous vessels and a new diagnosis of purpura fulminans was made, likely secondary to her sepsis. Unfortunately, despite aggressive medical and surgical treatment measures, this patient died of multiple organ dysfunction following a prolonged admission.
