Hoigne Syndrome Secondary to Intravenous Lidocaine in a Woman with Metastatic Ewing Sarcoma

Palliative care providers are increasingly using lidocaine infusions for refractory cancer pain. Hoigne syndrome (HS) is a rare psychiatric reaction that has been reported after local anesthetic usage, but has not been described in the palliative care setting. We report a case of a young woman with metastatic Ewing sarcoma who developed HS days after starting a lidocaine infusion. Given the improvement in her pain since initiation of lidocaine, the decision was made to continue the infusion and medically manage her HS. She had improvement with the addition of benzodiazepines and lowering the lidocaine infusion rate. Palliative care providers should be aware of HS as a possible side effect of lidocaine infusions and the unique challenges in managing it in patients near the end of life.