title: Painful ANA-positive scleroderma-like disease with acral ulcerations: a case of chronic gangrenous ergotism.
abstract: Chronic ergotism is a rare cause of limb ischemia. In this case report, the authors present a 62-year-old woman with history of long-term use of ergotamine alkaloids for the treatment of menstrual pain, who developed a severe painful disease initially misdiagnosed as systemic sclerosis (scleroderma) for 3 decades. She presented with a combination of acral gangrene, foot ulcer, renal obstruction, mild pulmonary fibrosis, and reduced esophageal motility. Right-sided renal obstruction was evident. The condition was extremely painful and had led to muscular contractions and immobility, drug abuse, and anemia. After establishing the diagnosis of chronic gangrenous ergotism, changing drug therapy, mobilization, and treatment of chronic wounds, she showed a remarkable recovery. Eventually the foot ulcer was closed successfully using a mesh graft transplantation, and the patient was able to walk alone. Chronic ergotism is rare but has to be taken into account when presented with painful chronic digital and foot ulcers.
authors.affiliation: Department of Dermatology and Allergology, Academic Teaching Hosputal of the Technical University of Dresden, Dresden, Germany. wollina-uw@khdf.de
authors.forename: Uwe
authors.initials: U
authors.lastname: Wollina
authors.forename: Gesine
authors.initials: G
authors.lastname: Hansel
authors.forename: Monika
authors.initials: M
authors.lastname: Gruner
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Schönlebe
authors.forename: Birgit
authors.initials: B
authors.lastname: Heinig
authors.forename: Erich
authors.initials: E
authors.lastname: Köstler
mesh_terms: D002908:Chronic Disease; D003951:Diagnostic Errors; D004412:Dysmenorrhea / Q000188:drug therapy; D004878:Ergotamine / Q000009:adverse effects*; D004881:Ergotism / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D016523:Foot Ulcer / Q000139:chemically induced* / Q000175:diagnosis* / Q000473:pathology; D005734:Gangrene; D006801:Humans; D008875:Middle Aged; D012595:Scleroderma, Systemic / Q000175:diagnosis*; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents; D004878:Ergotamine