A member presented a medical case:
After having DRESS syndrome felt due to a spinal orthopedic implant, the implant was removed but the patient developed body aches and an electrically charged upper body sensation.
Following back surgery back in August 2014 where an investigational artificial facet joint was installed. It turned out that I was severely allergic to the metal (cobalt) that the device was made out of. As a result, I got very sick,. First I got a severe case of DRESS Syndrome. (11 days in the hospital) I was treated with high doses of steroids for months. But shortly after in Oct. I became very sick again with three abscesses in my colon which was then removed. Shortly after I lost the use of my legs. Had back surgery where they found a lot of foreign material, new scar tissue and new bone growth. Cleaned it out got my legs back but only for about a month. Then began to loose my legs again. Was sent in for an allergy test to find out that I was allergic to the cobalt. The device was removed and I was fused. I have been steadily getting better. But, my question here is that during this period, which by the way required 5 additional less major operations, one of which was the worst pain experience I have ever experienced. CT scan with contrast. I have suffered from what I call body aches. But it also feels like my upper body is being mildly electrically charged. Ibuprofen was the only thing to help. But since my last operation that med is off the table. I have had weeks were the feeling seems to go away, only to return. I have been free of this condition for about a month, with the last back surgery on August 31, 2015. 9th total. Just in the last week the body aches are beginning to return. I have permanent lateral femoral neuralgia on both legs. So I have been taking gabapentin for several years. I have also been professionally diagnosed with PTSD, I guess from the trauma of all the surgeries and the associated pain and disability. I was also taking Wellbutrin but was just but on Cymbalta. Only taken one so far. Bottomline, the body aches are back or electrical charge is back. I can't seem to get an answer or any kind of treatment. Your suggestions.
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Patient demographics
Gender
male
Age
59
Ethnicity
White or Caucasian
Occupation
Judge
Chief complaint or problem to solve
After having DRESS syndrome felt due to a spinal orthopedic implant, the implant was removed but the patient developed body aches and an electrically charged upper body sensation.
Case history
Following back surgery back in August 2014 where an investigational artificial facet joint was installed. It turned out that I was severely allergic to the metal (cobalt) that the device was made out of. As a result, I got very sick,. First I got a severe case of DRESS Syndrome. (11 days in the hospital) I was treated with high doses of steroids for months. But shortly after in Oct. I became very sick again with three abscesses in my colon which was then removed. Shortly after I lost the use of my legs. Had back surgery where they found a lot of foreign material, new scar tissue and new bone growth. Cleaned it out got my legs back but only for about a month. Then began to loose my legs again. Was sent in for an allergy test to find out that I was allergic to the cobalt. The device was removed and I was fused. I have been steadily getting better. But, my question here is that during this period, which by the way required 5 additional less major operations, one of which was the worst pain experience I have ever experienced. CT scan with contrast. I have suffered from what I call body aches. But it also feels like my upper body is being mildly electrically charged. Ibuprofen was the only thing to help. But since my last operation that med is off the table. I have had weeks were the feeling seems to go away, only to return. I have been free of this condition for about a month, with the last back surgery on August 31, 2015. 9th total. Just in the last week the body aches are beginning to return. I have permanent lateral femoral neuralgia on both legs. So I have been taking gabapentin for several years. I have also been professionally diagnosed with PTSD, I guess from the trauma of all the surgeries and the associated pain and disability. I was also taking Wellbutrin but was just but on Cymbalta. Only taken one so far. Bottomline, the body aches are back or electrical charge is back. I can't seem to get an answer or any kind of treatment. Your suggestions.
Purpose of case discussion
Treatment decision: "What's the best treatment?"
Supplemental Materials

Dr. Ken Yonemura
Neurosurgery
9 doctors agree

In brief: Cobalt Chrome Allergy

This is a difficult situation as removal of the implants does not mean that all of the cobalt has been removed.
I am aware of two types of facet replacement and both utilize metal on metal technology that will result in metal and ionic debris that can still persist after the implants have been removed. Given the severity of your symptoms, small amounts of retained cobalt in scar tissue around the implants is likely the source of continued symptoms and there are no reliable methods to eradicate any remaining metal deposits. The lateral thigh symptoms are consistent with compression of the lateral femoral cutaneous nerves and the most common cause is from positioning during lumbar surgery in the prone position.

In brief: Cobalt Chrome Allergy

This is a difficult situation as removal of the implants does not mean that all of the cobalt has been removed.
I am aware of two types of facet replacement and both utilize metal on metal technology that will result in metal and ionic debris that can still persist after the implants have been removed. Given the severity of your symptoms, small amounts of retained cobalt in scar tissue around the implants is likely the source of continued symptoms and there are no reliable methods to eradicate any remaining metal deposits. The lateral thigh symptoms are consistent with compression of the lateral femoral cutaneous nerves and the most common cause is from positioning during lumbar surgery in the prone position.
Thank
Dr. William Witt
Anesthesiology
6 doctors agree

In brief: This is adhesive arachnoiditis. Further spinal surgery will probably make it worse.

I can advise you from both sides of the examination table as I am now quadriplegic myself.
You are having neuropathic pain and opioids will not be effective and may even make it worse. I would therefore try Lyrica first. The only procedure that I recommend is spinal cord stimulation. I have had the best success with the Boston Scientific product. They have an excellent website and you can read more about this matter there. My name is William O. Witt,MD, and you can look me up on line. There are other options but given that I am typing this with my tongue it is difficult for me to list them all. I hope you find this helpful.

In brief: This is adhesive arachnoiditis. Further spinal surgery will probably make it worse.

I can advise you from both sides of the examination table as I am now quadriplegic myself.
You are having neuropathic pain and opioids will not be effective and may even make it worse. I would therefore try Lyrica first. The only procedure that I recommend is spinal cord stimulation. I have had the best success with the Boston Scientific product. They have an excellent website and you can read more about this matter there. My name is William O. Witt,MD, and you can look me up on line. There are other options but given that I am typing this with my tongue it is difficult for me to list them all. I hope you find this helpful.
Thank
1 comment
Dr. Nicole Clark
Wow. Deepest admiration for you Dr Witt. How wonderful to share your personal story and advice!
Dr. Rikin Patel
Sports Medicine
5 doctors agree

In brief: Neuromodulation

The importance of a thorough non-surgical approach to your remaining symptoms is definitely important as recommended previously - Neuro/Immuno etc.
Your body may be dealing with chronic neuropathic pain based on your history for which most medications are only partially or ineffective. Your certainly have been through a lot. One area to look into is neuromodulation or spinal cord stimulation to help control both your back and leg symptoms. Hope that helps!

In brief: Neuromodulation

The importance of a thorough non-surgical approach to your remaining symptoms is definitely important as recommended previously - Neuro/Immuno etc.
Your body may be dealing with chronic neuropathic pain based on your history for which most medications are only partially or ineffective. Your certainly have been through a lot. One area to look into is neuromodulation or spinal cord stimulation to help control both your back and leg symptoms. Hope that helps!
Thank
Dr. John Chiu
Internal Medicine - Allergy & Immunology
5 doctors agree

In brief: Neurologist

These symptoms are more compatible with a neurologic disorder (including MS) than an allergic one.
Recommend a thorough neurologic evaluation.

In brief: Neurologist

These symptoms are more compatible with a neurologic disorder (including MS) than an allergic one.
Recommend a thorough neurologic evaluation.
Thank
1 comment
Dr. Patricia Saunders
recommend a thorough immunological assessment
Dr. Matthew Lyman
Orthopedic Surgery
4 doctors agree

In brief: Tough one

You might consider seeing a Physiatrist or a pain doctor. I wonder if you have tried neurontin or lyrica.
I also wonder if light exercise could help with the body aches? Maybe you are so inactive it is causing all this. I bet physical therapy is the next step for you to help. Unfortunately, though, chronic pain is probable. That pain doctor could help you outline a plan for medications to keep functional. I doubt that surgery would be a good idea at this point because of how much you have had already. It may sound crazy, but since western medicine has kind of failed you, why not try acupuncture or chiropractic? With time, the pain may decrease, but expect slow improvement I think.

In brief: Tough one

You might consider seeing a Physiatrist or a pain doctor. I wonder if you have tried neurontin or lyrica.
I also wonder if light exercise could help with the body aches? Maybe you are so inactive it is causing all this. I bet physical therapy is the next step for you to help. Unfortunately, though, chronic pain is probable. That pain doctor could help you outline a plan for medications to keep functional. I doubt that surgery would be a good idea at this point because of how much you have had already. It may sound crazy, but since western medicine has kind of failed you, why not try acupuncture or chiropractic? With time, the pain may decrease, but expect slow improvement I think.
Thank
Dr. John Goldman
Internal Medicine - Rheumatology
3 doctors agree

In brief: Has DRESS improved

DRESS is inflammatory.
These symptoms can be due to inflammation- thus may be related to DRESS which if did not improve may or may not be related to the implant or if due to implant may not have been completely removed or these symptoms may be related to the therapy for DRESS. You need to discuss with your physician

In brief: Has DRESS improved

DRESS is inflammatory.
These symptoms can be due to inflammation- thus may be related to DRESS which if did not improve may or may not be related to the implant or if due to implant may not have been completely removed or these symptoms may be related to the therapy for DRESS. You need to discuss with your physician
Thank
Dr. Peter Ihle
Orthopedic Surgery
3 doctors agree

In brief: First of all,allergy-

-2 the metal is not common, but also not rare.
The implant should have come out & fusion done, which would B 2 surgeries. Also why was IBP off limits? There are many alternatives for anti-inflammatory meds. Have they been tried? If it was due 2 stomach issues, the second generation ant's will usually leave Ur stomach alone. Also there R meds 2 treat stomach issues. Allergies to metals, cobalt, aluminum, nickel should always B suspect with allergic symptoms after an implant. I don't have any advice beyond what was stated, especially with PTSD & the aching. All I can do is wish U Good LUCK!

In brief: First of all,allergy-

-2 the metal is not common, but also not rare.
The implant should have come out & fusion done, which would B 2 surgeries. Also why was IBP off limits? There are many alternatives for anti-inflammatory meds. Have they been tried? If it was due 2 stomach issues, the second generation ant's will usually leave Ur stomach alone. Also there R meds 2 treat stomach issues. Allergies to metals, cobalt, aluminum, nickel should always B suspect with allergic symptoms after an implant. I don't have any advice beyond what was stated, especially with PTSD & the aching. All I can do is wish U Good LUCK!
Thank
Dr. Richard Zimon
Internal Medicine
3 doctors agree

In brief: Complimentary Medicine

specifically ACUPUNCTURE may be worth a trial.
Evaluation by a State Licensed Acupucturist followed by six treatments is the usual trial. It is very valuable for pain and fatigue in a significant # of very frustrating cases. Hope this helps! Z

In brief: Complimentary Medicine

specifically ACUPUNCTURE may be worth a trial.
Evaluation by a State Licensed Acupucturist followed by six treatments is the usual trial. It is very valuable for pain and fatigue in a significant # of very frustrating cases. Hope this helps! Z
Thank
2 comments
Dr. John Chiu
This patient has neurologic issues besides pain.
Dr. Edwin Perez
Accupuncture for this case.....I would not use complementary therapy in such a situation without a full investigation that turns up nothing.
Dr. Yasmin Pirani
Family Medicine
1 doctor agrees

In brief: DRESS syndrome

You have been through a lot.
I am glad the facet joint has now been fused, and the implant is no longer causing you trouble. As for the symptoms you are describing, the lateral femoral nerve fain, the weakness, the fatigue, they are non-specific and troublesome. My suggestion is to rule out the following: 1) Nerve damage from the surgery 2) Rheumatological work up to see if there are any serum markers that are elevated to reveal an underlying inflammatory/rheumatologic disorder 3) Rule out any underlying infections 4) Mood, Depression 5) Nutrition- In this category i think you should look into naturopathy, acupuncture etc... Physiotherapy to get you moving. All of these play a role in keeping one whole, and getting their insight can only be helpful. If u have more questions, please make an appointment with me any time convenient to you.

In brief: DRESS syndrome

You have been through a lot.
I am glad the facet joint has now been fused, and the implant is no longer causing you trouble. As for the symptoms you are describing, the lateral femoral nerve fain, the weakness, the fatigue, they are non-specific and troublesome. My suggestion is to rule out the following: 1) Nerve damage from the surgery 2) Rheumatological work up to see if there are any serum markers that are elevated to reveal an underlying inflammatory/rheumatologic disorder 3) Rule out any underlying infections 4) Mood, Depression 5) Nutrition- In this category i think you should look into naturopathy, acupuncture etc... Physiotherapy to get you moving. All of these play a role in keeping one whole, and getting their insight can only be helpful. If u have more questions, please make an appointment with me any time convenient to you.
Thank
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