Erythromelalgia mimicking diabetic foot infection: diagnostic challenges and contraindication of ice application

BACKGROUND: Erythromelalgia (EM) is a neurovascular disorder with an estimated incidence of 0.25-2 cases per 100,000 people, characterized by episodic burning pain, erythema, and increased skin temperature, primarily in the extremities. Its presentation can be mistaken for diabetic foot infection (DFI), leading to diagnostic dilemmas and potentially harmful therapeutic interventions. CASE PRESENTATION: A 62-year-old Han Chinese woman with diabetes presented with recurrent redness, swelling, burning pain, and ulceration on both feet. She was once misdiagnosed as DFI, but was finally confirmed as EM based on characteristic symptoms (heat intolerance, relief with cautious cooling) in the absence of infectious signs (fever, leukocytosis, or purulence). During the treatment, the patient was significantly alleviated. However, she suffered from gangrene and went through amputation due to use of ice packs. CONCLUSION: This case not only demonstrates the critical importance of differentiating EM from DFI, but also emphasizes the necessity of avoiding ice therapy in its management, providing valuable insights for clinical practice.