title: [Ergotism secondary to ergotamine-ritonavir association. Report of three cases].
abstract: Ergotism is a complication of the acute intoxication or chronic abuse of ergot derivatives. It may be manifested by a vasomotor syndrome with peripheral vascular disease frequently involving extremities. We report three patients infected with human immunodeficiency virus (HIV), in antiretroviral treatment (ART) that included a protease inhibitor as ritonavir, and had received self-medicated ergotamine. They developed symptoms of peripheral vascular disease and the physical examination showed no arterial pulses in the affected vessels. Arterial Doppler confirmed signs of diffuse arterial spasm in all of them. An arteriography was performed to the second patient and it showed obliteration of the distal sector of the ulnar and radial arteries. Ergotism secondary to ergotamine-ritonavir association was diagnosed. Patients were treated discontinuing the administration of involved drugs, arterial vasodilators and prophylactic anticoagulation, with marked improvement of symptoms.
authors.affiliation: Centro de trabajo Clínica Médica A, Departamento Clínico de Medicina, Hospital de Clínicas Dr. Manuel Quíntela, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay. santiagoacle@gmail.com
authors.forename: Santiago
authors.initials: S
authors.lastname: Acle
authors.forename: Federico
authors.initials: F
authors.lastname: Roca
authors.forename: Mariela
authors.initials: M
authors.lastname: Vacarezza
authors.forename: Alfredo
authors.initials: A
authors.lastname: Álvarez Rocha
mesh_terms: D000328:Adult; D004347:Drug Interactions; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004878:Ergotamine / Q000506:poisoning*; D004881:Ergotism / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000139:chemically induced*; D019438:Ritonavir / Q000009:adverse effects*; D014662:Vasoconstrictor Agents / Q000506:poisoning
chemical_list: D017320:HIV Protease Inhibitors; D014662:Vasoconstrictor Agents; D019438:Ritonavir; D004878:Ergotamine