title: Chronic ergot toxicity presenting with bilateral external iliac artery dissection and lower extremity rest pain.
abstract: Chronic use of ergot alkaloids has been recognized as a rare cause of lower extremity ischemia. Most patients with ergot toxicity present with symptoms of lower extremity claudication. Herein we present a woman with bilateral lower extremity rest pain and a history of chronic ergot use for migraine headaches. Arteriography demonstrated extensive pruning of the distal arterial tree along with bilateral external iliac artery dissections - a finding that is not often associated with young, normotensive patients with chronic ergot toxicity. This patient was treated with endovascular stenting of the dissections along with cessation of ergot. Her symptoms improved markedly, and follow-up arteriography 6 weeks later demonstrated resolution of the iliac dissections along with restoration of nearly normal lower extremity runoff vessels. Discontinuation of ergot-containing products and cessation of tobacco and caffeine use is the cornerstone of therapy in chronic ergot toxicity. The association of ergot toxicity and iliac dissection has not been previously described. Endovascular or surgical interventions may be considered in patients with ergot toxicity for specific indications or those whose symptoms progress despite conservative management.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
authors.forename: Afshin M
authors.initials: AM
authors.lastname: Molkara
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abou-Zamzam
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Teruya
authors.forename: Christian
authors.initials: C
authors.lastname: Bianchi
authors.forename: J David
authors.initials: JD
authors.lastname: Killeen
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D017130:Angioplasty; D002110:Caffeine / Q000009:adverse effects*; D002908:Chronic Disease; D004338:Drug Combinations; D004878:Ergotamine / Q000009:adverse effects*; D004881:Ergotism / Q000209:etiology*; D005260:Female; D006801:Humans; D017543:Iliac Aneurysm / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D007383:Intermittent Claudication / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply*; D008881:Migraine Disorders / Q000188:drug therapy; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C037330:caffeine, ergotamine drug combination; D002110:Caffeine; D004878:Ergotamine