Ergotamine-induced lower extremity arterial vasospasm presenting as acute limb ischemia.
Ergotamine-induced limb ischemia is rare and usually results from an accidental overdose. Several agents, including erythromycin and tetracycline, raise serum ergotamine levels and augment its effect. We present a case of acute lower limb ischemia with characteristic angiography findings of diffuse arterial spasm resulting from use of ergotamine and an erythromycin derivative, clarithromycin. The history of the patient and classic features seen on angiography helped us establish the diagnosis. The patient was successfully treated with low molecular heparin and epidural infusion of bupivacain. Since ergot vasospasm is a self limited and medically treatable condition, interventional radiologists must be aware of ergotamine-induced acute limb ischemia to avoid any unnecessary interventional procedures, unless necrosis and gangrene are imminent.
Demir
Senay
S
Department of Radiology, Başkent University Adana Medical and Research Center, Adana, Turkey. drsenaydemir@hotmail.com
Akin
Sule
S
Tercan
Fahri
F
Ariboğan
Anis
A
Oğuzkurt
Levent
L
D000293:Adolescent; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D003490:Cyanosis / Q000139:chemically induced / Q000209:etiology; D004878:Ergotamine / Q000009:adverse effects* / Q000506:poisoning; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D007262:Infusions, Intravenous; D007866:Leg / Q000098:blood supply / Q000000981:diagnostic imaging; D010173:Palpation; D011859:Radiography; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D014661:Vasoconstriction; D014662:Vasoconstrictor Agents / Q000009:adverse effects
D014662:Vasoconstrictor Agents; D004878:Ergotamine; D002045:Bupivacaine