A 34-year-old woman was hospitalized for severe acute arterial insufficiency of the limbs. Overuse of ergotamine derivative was acknowledged by the patient, who had a long history of migraine headaches. An arteriogram showed diffuse arterial spasm and occlusion of right leg distal arteries. Intravenous infusion of a stable prostacyclin analog (Iloprost) was administered. Rapid and complete improvement of arteriospasm was noted within a few hours, confirmed by a further arteriogram. This appears to be one of the rare case reports of successful limb salvage by use of Iloprost for ergotism.
Get full access to this article
View all access options for this article.
References
1.
Schmidt R., Erasmi H., Walter M., et al: Ergotisme et ischémie des membresAnn Cardiol Angeiol41:489-495, 1992.
2.
Magee R.: St. Anthony's fire revisited: Vascular problems associated with migraine medicationMed J Aust154:145-149, 1991.
3.
Olin JW: Syndromes that mimic vasculitisCurr Opinion Cardiol6:768-774, 1991.
4.
Rall TW: Ergot and the ergot alkaloids In: Goodman and Gilman's: The Pharmacological Basis of Therapeutics, ed. 8, ed by Goodman Gilman A, Rall TW, Nies AS, et al. New York: Pergamon, 1990, pp 939-947.
5.
Keigley B., Vogelzang RL, Neiman HL, et al: Ergotism presenting as restenosis following angioplastyCardiovasc Intervent Radiol10:21-23, 1987.
6.
Baader W., Herman C., Johansen K.: Le feu de Saint Antoine: guérison du vasospasme périphérique dû à l'ergotamine par la dilatation artérielle hydrostatiqueAnn Chir Vasc4:597-599, 1990.
7.
Kermerer VF, Dagher FJ, Pais SO: Successful treatment of ergotism with nifedipineAm J Roentgenol143:333-334, 1984.
8.
Carliner NH, Denune DP, Finch CS, et al: Sodium nitroprusside treatment of ergotamine-induced peripheral ischemiaJAMA227:308-309, 1974.
Shifrin E., Olschwang D., Perel A., et al: Reversal of ergotamine-induced arteriospasm by mechanical intraarterial dilatationLancet13:1278-1279, 1980 .
11.
Levy JM, Ibrahim F., Nykamp PW, et al: Prostaglandin E1 for alleviating symptoms of ergot intoxication: A case reportCardiovasc Intervent Radiol7:28-30, 1984.
12.
Horstmann R. , Daum H., Heller M., et al: Critical limb ischemia caused by ergotism: Treatment with intraarterial prostaglandin E1 infusionDtsch Med Wochenschr118:1067-1071, 1993 .
13.
Edwards RJ, Fulde Gwo, McGrath MA: Successful limb salvage with prostaglandin infusion: A review of ergotamine toxicityMed J Aust155:825-827, 1991.
14.
Fiessinger JN, Schäfer M., for the TAO study: Trial of iloprost versus aspirin treatment for critical limb ischemia of thromboangiitis obliteransLancet335: 555-557, 1990.
15.
Dormandy J. : Use of the prostacyclin analogue iloprost in the treatment of patients with critical limb ischemiaTherapie46:319-322, 1991.
16.
Kyle MV, Belcher G., Hazleman BL: Placebo controlled study showing therapeutic benefit of iloprost in the treatment of Raynaud's phenomenonJ Rheumatol19:1403-1406, 1992.
17.
Gomez-Sanchez MA, De La Calzada CS, Gomez-Pajuelo C., et al: Different hemodynamic responses between acute and chronic infusion of Iloprost (prostacyclin-stable analogue) in severe pulmonary hypertensionAm Rev Respir Dis144:1404-1405, 1991 .
18.
Grant SM, Goa KL: Iloprost: A review of its pharmacodynamic and pharmacokinetic properties and therapeutic potential in peripheral vascular disease, myocardial ischemia and extracorporeal circulation proceduresDrugs43:889-924, 1992.
