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Abstract
Ergotism is a rare condition of acute vasospasm found classically in young and middle-aged women taking ergot alkaloid agents to treat migraine headache. We report the case of a young man with human immunodeficiency virus (HIV) positivity and describe the drug interaction between protease inhibitors and ergot alkaloid agents, which most likely predisposed to development of ergot toxicity. The HIV-positive population receiving antiviral therapy may be an under-recognized group at risk for ergotism through decreased hepatic metabolism of ergot preparations.
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Affiliation(s)
- Zachary K Baldwin
- Department of Surgery, Kaiser Permanente-Oakland, 280 W MacArthur Boulevard, Oakland, CA 94611, USA
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Papalampros EL, Salakou SG, Felekouras ES, Scopa C, Tsamandas AC, Bastounis E. Ischemic necrosis of gastric wall after long-term ergotamine pill abuse: case report and review of the literature. Dig Dis Sci 2001; 46:981-4. [PMID: 11341668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- E L Papalampros
- First Department of Surgery, University of Athens Medical School, Greece
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3
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Janssen van Doorn K, Van der Niepen P, van Tussenbroeck F, Verbeelen D. Acute tubulo-interstitial nephritis and renal infarction secondary to ergotamine therapy. Nephrol Dial Transplant 2000; 15:1877-9. [PMID: 11071983 DOI: 10.1093/ndt/15.11.1877] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Janssen van Doorn
- Department of Internal Medicine, Vrije Universiteit Brussel, Brussels, Belgium
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4
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Abstract
Although complications of generalized atherosclerosis most commonly cause intestinal ischemia, a number of unusual causes may be responsible. These unusual causes can be grouped into six major categories: (1) mechanical, (2) drugs, (3) hematologic, (4) endocrine, (5) vasculopathies, and (6) miscellaneous. Morbidity and mortality rates remain high because these rare diseases frequently go unrecognized until patients suffer adverse outcomes. A high index of suspicion may decrease the delay in diagnosis of mesenteric ischemia caused by these disorders.
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Affiliation(s)
- W C Krupski
- Department of Surgery, University of Colorado Health Sciences Center, Denver, USA
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Edwards RJ, Fulde GW, McGrath MA. Successful limb salvage with prostaglandin infusion: a review of ergotamine toxicity. Med J Aust 1991; 155:825-7. [PMID: 1745181 DOI: 10.5694/j.1326-5377.1991.tb94054.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE A case of severe acute peripheral arterial insufficiency secondary to ergotamine toxicity treated successfully with intravenously administered prostaglandin is presented to highlight the features of this condition and to demonstrate the efficacy of treatment with prostaglandin infusion. CLINICAL FEATURES A 35-year-old unemployed Caucasian woman with a background of polypharmacy abuse and recurrent migraines presented to St Vincent's Hospital Emergency Department with limb-threatening ischaemia of both legs secondary to chronic ergotamine overuse. INTERVENTION AND OUTCOME A prostaglandin infusion was started and a dramatic and rapid improvement of her peripheral circulation occurred within six hours. CONCLUSION Ergotamine toxicity is an uncommon but well documented cause of peripheral vascular insufficiency that should be recognised and treated aggressively because its sequelae can be disastrous. Intravenously administered prostaglandin proved to be successful in this case and is a logical choice as first-line therapy for ergotamine toxicity.
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Affiliation(s)
- R J Edwards
- Accident and Emergency Centre, St Vincent's Hospital, Darlinghurst, NSW
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7
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Abstract
A randomised, controlled trial of 1429 women was carried out to compare 'active' management of the third stage of labour, using i.v. Ergometrine 0.5 mgs, with a method of 'physiological' management, in women at 'low risk' to haemorrhage. A separate sub-study, with 168 women in each of the two groups, examined the possible effects of Ergometrine on serum prolactin levels and the duration of breast feeding. No difference was found in peak (post-suckling) serum prolactin levels taken from 126 women between 48 and 72 hours postnatal. Further studies with larger sample sizes would give a more dependable result. Women who did not receive the drug Ergometrine were more likely to continue breast feeding for longer than four weeks than those who did (p less than 0.05). It is recommended that this drug should not be given routinely to women intending to breast feed.
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Abstract
A randomised, controlled trial of 1429 women was carried out to compare 'active' management of the third stage of labour, using i.v. Ergometrine 0.5 mg, with a method of 'physiological' management, in women at 'low risk' to haemorrhage. In the "active" management group a higher incidence of the following complications was found:- manual removal of placenta (p less than 0.0005), problems such as nausea (p less than 0.0005), vomiting (p less than 0.0005), and severe after-birth pains (p less than 0.02), hypertension (p less than 0.0001) and secondary postpartum haemorrhage (p less than 0.02). The incidence of postpartum haemorrhage (blood loss greater than 500 ml) and postnatal haemoglobins less than 10 gm/100 were higher in the 'physiological' group (p less than 0.0005, p less than 0.002). No difference was found in the need for blood transfusion in either group. The routine use of i.v. Ergometrine 0.5 mg during the third stage of labour in women at 'low risk' to haemorrhage does not appear to be necessary and has many adverse effects. Further studies comparing different methods of 'physiological' management are recommended in order to reduce to a minimum the incidence of postpartum haemorrhage and anaemia.
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Wells KE, Steed DL, Zajko AB, Webster MW. Recognition and treatment of arterial insufficiency from Cafergot. J Vasc Surg 1986. [DOI: 10.1016/0741-5214(86)90316-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Venter CP, Joubert PH, Buys AC. Severe peripheral ischaemia during concomitant use of beta blockers and ergot alkaloids. BRITISH MEDICAL JOURNAL 1984; 289:288-9. [PMID: 6430442 PMCID: PMC1442151 DOI: 10.1136/bmj.289.6440.288-a] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
Three days after initiation of migraine headache therapy with ergotamine tartrate and propranolol, severe acute arterial insufficiency of the lower extremities developed in a 48-year-old woman who had been in general good health. Angiography revealed hypoplastic aortoiliac arteries, with tubular narrowing of the leg arteries. Lower extremity blood pressures rapidly returned to normal with a single intraarterial injection of 25 mg of tolazoline. Cases of peripheral ischemia due to either ergotamine or propranolol have been reported. Combined use of these two drugs may enhance the risk of acute arterial compromise.
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Fielding JW, Donovan RM, Burrows FG, Hurlow RA. Reversible arteriopathy following an ergotamine overdose in a heavy smoker. Br J Surg 1980; 67:247-50. [PMID: 7388303 DOI: 10.1002/bjs.1800670406] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A case of reversible arteriopathy developing in a heavy cigarette smoker taking an overdose of ergotamine is reported. Characteristic radiological changes are illustrated and the aetiology and management of this condition are discussed.
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Abstract
A case of ergotamine overdosage which produced vascular insufficiency in a 26-year-old female is described. She was treated successfully with the intravenous infusions of sodium nitroprusside and low molecular weight dextran, and anticoagulation with heparin. It is suggested that sodium nitroprusside may represent the drug of first choice in this condition.
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Hansteen V, Eika C, Birkeland S. Ergotism in a patient with a portosystemic shunt. Eur J Clin Pharmacol 1979; 16:425-6. [PMID: 527639 DOI: 10.1007/bf00568205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A case of ergotism is described in a patient with Banti's syndrome in whom a porto-systemic shunt had been made three times. She was admitted to hospital with severe ischaemia of the extremities after having taken a single oral dose of 1 mg ergotamine tartrate. Her condition improved rapidly after 2 to 3 days and the circulation was normal after one week. The possible mechanism of ergotism in this patient is discussed. Although the plasma concentration of ergotamine was not measured, the likeliest explanation was that the serious side effects were related to the altered pharmacokinetics and loss of first-pass metabolism of the drug due to the venous bypass of the liver.
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Fitzgerald B. Saint Anthony's fire or carpal tunnel syndrome? (a case of iatrogenic ergotism). THE HAND 1978; 10:82-6. [PMID: 710987 DOI: 10.1016/s0072-968x(78)80031-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A case of unilateral upper limb ischaemia from ergot overdosage is presented. An unusual feature was a median nerve neuropathy suggestive of carpal tunnel syndrome. The arteriographic appearances are demonstrated and management discussed.
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Ravid M, Robson M, Feigl D. Peripheral vascular disease and periodic paralysis caused by drug abuse. Angiology 1976; 27:685-7. [PMID: 1078302 DOI: 10.1177/000331977602701202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- M Ravid
- Department of Medicine, Jaffa Government Hospital, Sackler School of Medicine, Tel Aviv University, Israel
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Robb LG. Severe vasospasm following ergot administration. West J Med 1975; 123:231-5. [PMID: 1162985 PMCID: PMC1130393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Semb BK, Molster A, Halvorsen JF, Tvete S. Ergot-induced vasospasm of the lower extremities treated with epidural anaesthesia. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1975; 9:254-8. [PMID: 1209209 DOI: 10.3109/14017437509138647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
No reliable treatment to reverse severe ergot-induced vasopasm is available. A case of ergotamine-induced vasospasm of the lower extremities is presented. A combined treatment of vasodilators, infusion of low molecular dextran and high epidural anaesthesia apparently prevented extremity gangrene from occurring.
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Merhoff GC, Porter JM. Ergot intoxication: historical review and description of unusual clinical manifestations. Ann Surg 1974; 180:773-9. [PMID: 4371616 PMCID: PMC1343691 DOI: 10.1097/00000658-197411000-00011] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Clinical ergotism as seen today results almost exclusively from the excessive intake of ergotamine tartrate in the treatment of migraine headache. Although both gangrenous and convulsive symptoms are seen in naturally occurring ergotism resulting from the ingestion of fungus infected rye, only gangrenous ergotism has been reported following the excessive ingestion of ergotamine tartrate. The symptoms of both iatrogenic and naturally occurring ergotism appear to result from regional ischemia caused by ergot induced vasospasm. This report discribes experiences in the diagnosis and management of two patients with unusual manifestations of iatrogenic ergotism. One patient presented with ischemia of all extremities and bilateral foot drop probably due to ischemic damage to the common peroneal nerves, a finding not previously described in ergot intoxication. The foot drop totally resolved in several months following the discontinuation of ergot. A second patient presented with unilateral leg ischemia and transient monocular blindness, both of which resolved after discontinuation of ergot. Both patients displayed typical angiographic findings of ergotism. There is no convincing evidence that any treatment other than discontinuation of ergotamine is of benefit in the treatment of iatrogenic ergotism.
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Abstract
A patient is described who developed venous thrombosis in the leg following an intramuscular injection of ergotamine tartrate.
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Herlache J, Hoskins P, Schmidt CM. Ergotism. Unilateral brachial artery thrombosis secondary to ergotamine tartrate. Angiology 1973; 24:369-73. [PMID: 4712163 DOI: 10.1177/000331977302400607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Syme J. Ergotamine-induced peripheral arterial spasm: clinical and angiographic diagnosis. AUSTRALASIAN RADIOLOGY 1971; 15:45-51. [PMID: 5103602 DOI: 10.1111/j.1440-1673.1971.tb01231.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Tator CH, Heimbecker RO. Unilateral arm ischemia due to ergotamine tartrate. CANADIAN MEDICAL ASSOCIATION JOURNAL 1966; 95:1319-21. [PMID: 5928531 PMCID: PMC1935854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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St. Anthony's Fire Rekindled. CANADIAN MEDICAL ASSOCIATION JOURNAL 1960; 83:658-659. [PMID: 20326453 PMCID: PMC1938681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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