« Docteur, ma rotule s'est envolée ! » - À propos de douleurs neuropathiques chez un patient cocaïnomane co-infecté par le VIH et le VHC

We report the case of a 46-year male with heroin and cocaine addictions and HIV-HCV co-infection, under methadone, treated in hospital for a staphyloccal endocarditis and presenting with multiple pain sites: thoracic nociceptive pain secondary to pulmonary septic infarctions ; bilateral unpleasant paresthesia and amyotrophy in both legs (fibular nerve territory): VAS score 4/10, DN4 score 6/10; multimodal hypoesthesia coexisting with intense pain in the left patella: VAS score 8/10, DN4 score 5/10 and a history of cocaine extravasation near the cutaneous anterior and medial nerve of the left thigh. Paresthesia in both lower limbs and pain in the left patella were relieved by oral gabapentin. Mechanisms for neuropathic pain in this case are discussed: peripheral neuropathy, cocaine neurotoxicity.