Sudeck’s Atrophy of the Left Tibiotarsal Joint in a Renal Transplant Patient: Effects of Medical and Physical Therapy

Dr. Claudio Campieri, Department of Nephrology, S. Orsola University Hospital, via Massarenti 9, I-40138 Bologna (Italy) Dear Sir, In view of the diversity of osteoarticular entities affecting the transplanted patient, special attention must be paid to Sudeck’s atrophy [1-3]. To our knowledge, no such cases have been reported up to now. Sudeck’s atrophy manifests as pain restricted to a bone segment, palpable edema, vasomotor skin instability, and focal bone deminerali-zation. A 49-year-old woman with a cadaver donor renal transplant since June 1982 complained of acute pain in the left ankle with hypothermia of the same leg in March 1992. The graft function had always been normal, and treatment included azathioprine 100 mg and prednisone 10 mg daily. Both X-ray and Doppler sonography of the left tibiotarsal joint were negative. After 15 days during which pain continued, the ankle swelled, and walking became difficult (fig. la). A repeat X-ray revealed traces of mottling and an irregularity in frontal cortex of the left astragalus, with swelling of the soft periarticular tissues. Bone technetium scintigraphy showed accumulation of the marker substance at left tibiotarsal joint and homolateral knee, while the iliofemoral-popliteal axis appeared normal. Nuclear magnetic resonance imaging and computerized tomography of the tibiotarsal joint exluded any focal bone lesions of the segment examined, only visualizing the Fig. 1. Ankle swelling (a) regressed after 5 months of therapy (b).