Pramipexole-induced limb dystonia and its associated complex regional pain syndrome in idiopathic Parkinson's disease

RATIONALE This case may be due to basal ganglia dysfunction, which was probably caused by abnormal activation of dopamine 1-like receptor (D1R) boosted by pramipexole binding on dopamine 3-like receptor (D3R) in a situation where D3R was overexpressed by the chronic treatment of L-dopa. PATIENT CONCERNS Striatal hand and foot deformities. DIAGNOSES Striatal hand and foot deformities with CRPS. INTERVENTIONS Steroid treatemnt and withdrawal of the pramipexole. OUTCOMES Recovered significantly. LESSONS Since the degree of overexpression of D3R is increased in a high dose of pramipexole, for patients with PD who are treated with L-dopa chronically, a new use of pramipexole and an increase in dose to alleviate the symptoms of PD should be implemented with caution while closely observing the occurrence of drug-induced complications such as dystonia and CRPS.