Persistent orocutaneous and anal fistulae induced by nicorandil: a case report.
BACKGROUND
Although nicorandil is prescribed widely, awareness of its potential to cause serious complications to the gastrointestinal tract mucosa is limited. Whilst nicorandil-induced oral and anal ulceration is well documented in the literature, nicorandil-induced fistulation is not. This is the first report in the literature of a single patient demonstrating simultaneous orocutaneous and anal fistulae during nicorandil therapy. Two separate cases of orocutaneous and anal fistulae associated nicorandil usage have previously been documented in specialist journals.


METHODS
A 71-year-old Caucasian man presented with a 3-year history of concurrent orocutaneous and anal fistulae. He had been exposed to 30 mg twice-daily nicorandil therapy for 4 years. Both fistulae responded poorly to intensive and prolonged conventional treatment but healed promptly on reduction and eventual withdrawal of nicorandil therapy.


CONCLUSIONS
Management of resistant cases of orocutaneous and anal fistulae in patients on high-dose nicorandil therapy may be impossible without reduction or even withdrawal of nicorandil.
Goh
Cyndi
C
Department of Medicine, Hinchingbrooke Hospital, Hinchingbrooke Heath Care NHS Trust, Huntingdon, Cambridgeshire PE29 6NT, UK.
Wong
Sally Cy
SC
Borland
Colin
C