title: Sildenafil in severe peripheral ischemia induced by terlipressin. A case report.
abstract: A female patient in the sixth decade of life developed renal failure secondary to gastrointestinal bleeding, which was non-responsive to conventional therapy. She was treated with terlipressin iv; showing improvement but developing, over the next few days, ischemia and necrosis of the toes in the lower extremities, simulating necrotizing vasculitis, without response to regular management. An alternative therapy, oral sildenafil 50mg BID, was used, with a rapid reversal of the clinical picture. The vasodilator action of sildenafil is useful in cases of ischemia induced by some drugs. The objective this report is to warm about the utility of sildenafil in some potentially severe cases, like the one above.
authors.affiliation: Specialty Consult Rheumatology, Unidad Médica Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Puebla, Pue, México. davra43@yahoo.com
authors.forename: David D
authors.initials: DD
authors.lastname: Bañuelos Ramírez
authors.forename: Silvia
authors.initials: S
authors.lastname: Sánchez Alonso
authors.forename: María Magdalena
authors.initials: MM
authors.lastname: Ramírez Palma
mesh_terms: D003937:Diagnosis, Differential; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007511:Ischemia / Q000139:chemically induced / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000209:etiology; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use*; D010488:Polyarteritis Nodosa / Q000175:diagnosis; D011687:Purines / Q000627:therapeutic use; D012771:Shock, Hemorrhagic / Q000150:complications / Q000188:drug therapy; D000068677:Sildenafil Citrate; D013450:Sulfones / Q000627:therapeutic use*; D000077585:Terlipressin; D014034:Toes / Q000098:blood supply*; D014662:Vasoconstrictor Agents / Q000009:adverse effects* / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D008236:Lypressin; D000077585:Terlipressin; D000068677:Sildenafil Citrate