Hello all,

2016 update.

Continued progression of neuropathic pain to include dysesthesias, lancinating pain in my fingers and feet.

New developments in late 2015 include puffy, red, mottled palms when below my heart, which drain to white above my heart.

New developments in 2016 include sternal chest pain, dyspnea (pain with deep breathing).

Abnormal labs/studies: in 2014 a skin biopsy confirmed small fiber neuropathy. This disproved one of Mayo's hypotheses that this is purely a central sensitization syndrome.

Rheumatology is working up a neurovascultis, possible nerve biopsy to do.

The objective finding of mottled, discolored palms are new, and worrisome. I also have subjective but not objective flushing in the face and neck.

Has anyone ever heard of a superior vena cava syndrome beginning with erythema of the palms without edema? The presence of chest pain, dyspnea, facial flushing and palmar erythema are raising the possibility of a superior vena cava syndrome, which would classically be caused by a mediastinal mass. Of course, given the history of mysterious neurologic symptoms and progressive joint distrubances, one possibility would be a thymoma, which is associated with myasthenia gravis not to mention high rates of a variety of paraneoplastic neuropathic syndromes; and rheumatologic diseases of all stripes. I have done a plain PA film of the chest (negative) but thymomas are often seen only on lateral view, or on high res CT of the chest, which of course I would avoid if possible given radiation exposure.

So if anyone with any experience with thymomas would care to chime in... feel free.