Reumatología Clínica

Reumatología Clínica

Volume 7, Issue 1, January–February 2011, Pages 59-60
Reumatología Clínica

Caso clínico
Sildenafil in severe peripheral ischemia induced by terlipressin. A case reportSildenafil en isquemia periférica severa inducida por tarlipresina. Reporte de un caso

https://doi.org/10.1016/j.reuma.2010.05.005Get rights and content

Abstract

A female patient in the sixth decade of life developed renal failure secondary to gastrointestinal bleeding, which was non-responsive to conventional therapy. She was treated with terlipressin iv; showing improvement but developing, over the next few days, ischemia and necrosis of the toes in the lower extremities, simulating necrotizing vasculitis, without response to regular management. An alternative therapy, oral sildenafil 50 mg BID, was used, with a rapid reversal of the clinical picture. The vasodilator action of sildenafil is useful in cases of ischemia induced by some drugs. The objective this report is to warm about the utility of sildenafil in some potentially severe cases, like the one above.

Resumen

Una paciente de la sexta década de la vida desarrolló fallo renal secundario a hemorragia digestiva incoercible, con datos de choque hipovolémico, por lo que fue tratada con tarlipresina iv, con lo que hubo mejoría, pero presentó isquemia y necrosis de los dedos en extremidades inferiores, simulando vasculitis necrotizante sin respuesta al manejo terapéutico habitual, por lo que se empleó como alternativa sildenafil oral 50 mg 2 veces al día, con reversión rápida de su cuadro clínico. La acción vasodilatadora del sildenafil demostró ser una opción útil en el presente caso y el objetivo de esta comunicación es alertar de la respuesta satisfactoria al sildenafil en casos de isquemia inducida por medicamentos, semejantes a lo que se presenta en la práctica médica.

Section snippets

Case report

A 51 year-old woman came to the emergency room with a history of alcoholic cirrhosis, portal hypertension, and esophageal varices (previously treated with sclerotherapy) and chronic renal failure, with her last creatinine clearance measured at 40 ml/h. She was classified as Child-Pugh C. She had presented upper digestive tract bleeding for 12 h. After 24  with persistent hemorrhage, intravenous terlipressin was added to the management (4 mg/24 h); on the third day after treatment, she developed

Discussion

Sen et al described a possible toxic effect of terlipressin related to its vasoconstrictor action.1 Terlipressin has been associated with peripheral ischaemia2 and vasculitis-like lesions, like the ones observed in this case. Sildenafil is a selective inhibitor of GMP-phosphodiesterase with an effect on microvascular and macrovascular circulation, approved for use in erectile dysfunction, pulmonary arterial hypertension, and recently described by Fries et al for use in Raynaud's phenomenon in

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