title: Paradoxical reaction of raynaud phenomenon following the repeated administration of iloprost in a patient with diffuse cutaneous systemic sclerosis.
abstract: OBJECTIVE
  To report a paradoxical reaction of Raynaud phenomenon following the repeated administration of iloprost in a patient with diffuse cutaneous systemic sclerosis with vascular involvement.
  
  
  METHODS
  In January 2006, a 40-year-old male was diagnosed with diffuse cutaneous systemic sclerosis with pulmonary, esophageal, cutaneous, and vascular involvement (Raynaud phenomenon, with digital ulcers on his hands). In December 2008, treatment with iloprost was started due to worsening disease. Nine cycles of iloprost were administered at a rate of 0.5-1 ng/kg/min (6 hours per day, for 5 days every 6-8 weeks); the patient tolerated this treatment well. However, on the fourth day of cycles 10 and 11, the patient developed paradoxical Raynaud phenomenon in the hand with perfusion when the infusion was increased to 1 ng/kg/min, requiring treatment to be stopped. Treatment was continued during cycles 12 and 13 at 0.5 ng/kg/min; the patient tolerated the treatment well, although paradoxical Raynaud phenomenon occurred when the rate of infusion was increased.
  
  
  CONCLUSIONS
  Raynaud phenomenon is extremely common in patients with scleroderma, and often is severe. Iloprost has vasodilating, antiplatelet, cytoprotective, and immunomodulating properties, and has been found to be an efficacious alternative to nifedipine for the treatment of Raynaud phenomenon in patients with scleroderma. The Naranjo probability scale indicated that iloprost was the probable cause of the paradoxical Raynaud phenomenon in this patient.
  
  
  CONCLUSIONS
  This case demonstrates a probable relationship between the rate of infusion of iloprost and the paradoxical reaction of Raynaud phenomenon.
authors.affiliation: Department of Pharmacy, Ferrol Health District, Spain. rebeca_ib@sefh.es
authors.forename: Rebeca Iglesias
authors.initials: RI
authors.lastname: Barreira
authors.forename: Belén Bardán
authors.initials: BB
authors.lastname: García
authors.forename: Mónica Granero
authors.initials: MG
authors.lastname: López
authors.forename: Iria Rodríguez
authors.initials: IR
authors.lastname: Legazpi
authors.forename: Hortensia Álvarez
authors.initials: HÁ
authors.lastname: Díaz
authors.forename: Isaura Rodríguez
authors.initials: IR
authors.lastname: Penín
mesh_terms: D000328:Adult; D006801:Humans; D016285:Iloprost / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D011928:Raynaud Disease / Q000139:chemically induced*; D045743:Scleroderma, Diffuse / Q000188:drug therapy*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D014665:Vasodilator Agents; D016285:Iloprost