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CC BY 4.0 · World J Nucl Med
DOI: 10.1055/s-0045-1812054
Case Report

Complex Regional Pain Syndrome Triggered by Snake Bite: Diagnostic Utility of Triple-Phase Single-Photon Emission Computed Tomography-Computed Tomography Bone Scan—Case Report

Authors

  • Osama Ragab

    1   Department of Nuclear Medicine, Al-Adan Hospital, Ministry of Health, Kuwait

  • Haneen Alqattan

    1   Department of Nuclear Medicine, Al-Adan Hospital, Ministry of Health, Kuwait

  • Manar Al Daas 

    1   Department of Nuclear Medicine, Al-Adan Hospital, Ministry of Health, Kuwait

  • Hany M. A. Elrahman

    1   Department of Nuclear Medicine, Al-Adan Hospital, Ministry of Health, Kuwait
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Abstract

Complex regional pain syndrome (CRPS) is a chronic pain disorder with complex pathophysiology involving neurogenic inflammation and autonomic dysfunction. While CRPS is typically associated with trauma or surgery, its occurrence following a snakebite is extremely rare. We report the case of a 47-year-old man who developed persistent pain, swelling, and hypersensitivity in the left foot after a snakebite to the dorsum. Despite prompt administration antivenom and admission to the intensive care unit, the symptoms progressed without systemic infection. Magnetic resonance imaging (MRI) revealed evolving soft tissue inflammation, fat necrosis, and periostitis. Triple-phase bone scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) demonstrated increased perfusion and periarticular tracer uptake consistent with CRPS, while effectively excluding osteomyelitis and abscess. The diagnosis was established using the Budapest criteria, supported by clinical assessment and multimodal imaging, including evidence of evolving periostitis without cortical bone destruction. This case underscores the diagnostic challenge of CRPS in the absence of infection or trauma and highlights the crucial role of MRI and triple-phase bone scintigraphy with SPECT/CT in detecting early osseous involvement and guiding appropriate management.

Keywords

complex regional pain syndrome - snake bite - MRI - bone scan - SPECT/CT

Patient Consent

Patient's written consent for the publication of this case and images was taken.


Data Availability Statement

Supporting data are available from the corresponding author upon reasonable request.


Authors' Contributions

O.R.: Provided expert input on nuclear medicine aspects, interpreted the SPECT-CT findings, and supervised the clinical case management. H.A.: Collected clinical data, reviewed imaging findings, conducted the literature review, and contributed to manuscript drafting. M.A.D.: Assisted in image interpretation and preparation of figures. H.M.A.E.: Contributed to the conception and design of the study and participated in manuscript writing and revisions. All authors read and approved the final version of the manuscript and agree to be accountable for all aspects of the work.




Publication History

Article published online:
04 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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