A Conversion Disorder Case Study of a Patient Who Underwent General Anesthesia for Dental Treatment as It Was Suspected That She Was Allergic to the Drugs Used in Local Anesthesia

<p>The patient was a 19-year-old girl. In August 2008, she exhibited signs of convulsions and was sent by emergency transport to our hospital. However, detailed examinations revealed no recognizable neurological abnormalities. Subsequently, conversion disorder was diagnosed, and she was admitted to the psychiatry clinic from December 2008 to January 2009 for treatment. In April 2010, she developed rashes, globus syndrome, a sharp fall in blood pressure, and tremors in all four limbs after an epidural block was administered using lidocaine hydrochloride. She was suspected to be allergic to lidocaine hydrochloride. On three separate occasions between June 2010 and November 2011, we performed various allergy tests using intradermal skin testing followed by an incremental subcutaneous challenge in the dermatology clinic of our hospital with all types of drugs used for local anesthesia. In March 2012, she was advised by the dermatology department to undergo treatment for her dental cavities in our dental treatment clinic. She required immediate dental work for many teeth. We then performed two intensive, separative dental surgeries under general anesthesia between May 2012 and June 2014.</p><p>In this case, it was difficult to distinguish the autonomic symptoms of conversion disorder, which consisted of the supposed hysteric attack with the anaphylactic reaction due to an allergy to a local anesthetic. Even though it is rare to develop an anaphylactic reaction to local anesthetic, we could not entirely dismiss the possibility, since the abnormal symptoms displayed by the patient were life-threatening. Therefore, we decided that use of local anesthesia should be avoided in her dental treatments. In this case, based comprehensively on the findings of the examination and clinical course, we decided to perform the dental treatment under general anesthesia without using a local anesthetic. As a result, the surgery and postoperative course were completed without any complications, enabling us to carry out the perioperative management safely.</p>