Two observations raising questions about risk factors of cutaneous necrosis induced by terlipressin (Glypressin).
BACKGROUND
Triglycyl lysine vasopressin (terlipressin, Glypressin) is a potent vasoconstrictive drug which became popular because of its prolonged duration of action, ease of administration and lower incidence of side effects. Ischemic complications are rare but may be life threatening.


METHODS
Case 1, a 68-year-old man with alcoholic cirrhosis and hepatocellular carcinoma, was admitted due to acute functional renal failure. He was first treated for septic shock with intravenous catecholamines. He then developed hepatorenal syndrome and received terlipressin as intravenous bolus (4 mg/day). Three days later, he presented a diffuse purpuric and necrotic eruption with tongue ischemia. He died from Staphylococcus aureus infection. Case 2, a 74-year-old man with metastatic carcinoma, presented severe renal insufficiency. He developed sepsis and pseudohepatorenal syndrome, which was treated with terlipressin (0.5 mg/h) using an infusion pump. Four days later, he developed an isolated large erythematous and purpuric macular plaque of the scalp near skin metastases. The patient died a few weeks later from tumor progression. In both cases, skin biopsies showed ischemic necrosis caused by thrombosis of superficial dermal capillaries.


CONCLUSIONS
These cases point to the risk of either widespread or localized necrosis. Although the precise incidence of these events as well as risk factors remain to be determined, hypovolemia, concomitant administration of vasoactive drugs and the mode of administration of terlipressin may influence the occurrence of these complications.
Mégarbané
Hala
H
Department of Dermatology and Allergology, Hôpital Tenon, Université Pierre-et-Marie-Curie (Paris-VI), Paris, France. hala_abirached@hotmail.com
Barete
Stéphane
S
Khosrotehrani
Kiarash
K
Izzedine
Hassan
H
Moguelet
Philippe
P
Chosidow
Olivier
O
Frances
Camille
C
Aractingi
Selim
S
D000368:Aged; D006801:Humans; D007511:Ischemia / Q000139:chemically induced; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D009336:Necrosis; D012307:Risk Factors; D012867:Skin / Q000098:blood supply / Q000187:drug effects / Q000473:pathology*; D012871:Skin Diseases / Q000139:chemically induced*; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000009:adverse effects
D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin