RESUMEN
Ergotism is an uncommon condition that affects patients with exposure to ergot alkaloids causing ischemia of extremities. We report the case of lower extremities ischemia caused by ergot toxicity in a human immunodeficiency virus (HIV) positive individual due to the interaction between ergot alkaloid and Cobicistat. In addition, we present a brief review of medical, and pharmacological aspects of this condition. To our knowledge, this is the second reported case describing this interaction.
Asunto(s)
Agonistas de Receptores Adrenérgicos alfa 1/efectos adversos , Fármacos Anti-VIH/efectos adversos , Cobicistat/efectos adversos , Ergotamina/efectos adversos , Ergotismo/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Isquemia/inducido químicamente , Extremidad Inferior/irrigación sanguínea , Interacciones Farmacológicas , Ergotismo/etiología , Infecciones por VIH/complicaciones , Humanos , Masculino , Trastornos Migrañosos/tratamiento farmacológico , Adulto JovenRESUMEN
Acute limb ischemia induced by arterial vasospasm remains an exceptional situation, favoured by the use of arterial vasoconstrictors. The risk of these substances is largely underestimated in the general population, especially with the co-administration of strong cytochrome inhibitors like human immunodeficiency virus (HIV) protease inhibitors. A 33-year-old woman, who used to take dihydroergotamine for orthostatic hypotension, was prescribed a post-exposure HIV prophylaxis including lopinavir and ritonavir. One day later, she presented an acute bilateral limb ischemia with a sudden pain in both calves, initially while walking and then at rest with bilateral ischemic toes. Angiography confirmed diffuse arterial vasospasm of the lower limb arteries. A first-line therapy with isosorbide dinitrate and amlodipine was ineffective, with rapid clinical worsening. A combination of intra-arterial injections and intra-venous infusions of vasodilators, transluminal balloon angioplasty and bilateral 4-Compartment fasciotomies permitted rapid improvement and finally resulted in both lower limbs rescue. This case and literature review illustrate ergotism due to ergotamine overdose after taking HIV protease inhibitors. It also demonstrates the benefit of an interventional procedure besides medical therapy with vasodilators in severe arterial vasospasm. All along the lower limb arterial tree, transluminal balloon angioplasty restored the blood flow, without vasospasm recurrence. CONCLUSION: In case of ergotism with acute lower limbs ischemia, combining medical vasodilator therapy with interventional procedure can restore the arterial blood flow, thus allowing to save lower limbs.
Asunto(s)
Angioplastia de Balón , Dihidroergotamina/efectos adversos , Ergotismo/etiología , Inhibidores de la Proteasa del VIH/efectos adversos , Isquemia/terapia , Vasoconstrictores/efectos adversos , Enfermedad Aguda , Adulto , Ergotismo/diagnóstico , Ergotismo/fisiopatología , Femenino , Infecciones por VIH/prevención & control , Humanos , Isquemia/inducido químicamente , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Extremidad Inferior/irrigación sanguínea , Factores de Riesgo , Resultado del TratamientoRESUMEN
Ergotism is an ischaemic complication due to vasoconstriction throughout the body due to ingestion of ergotamine. A 34-year-old Hispanic man with HIV infection treated with saquinavir, ritonavir and abacavir/lamivudine presented to the emergency department complaining of left foot pain 1 week prior to admission. The affected extremity was cold with absence of pedal and tibial pulses. Arterial Doppler revealed absent arterial flow from the popliteal artery later confirmed by arteriography. Medication reconciliation revealed a recent prescription for migraine headache containing ergotamine. Drug was discontinued and the patient was started on cilostazol, enoxaparin and nitroglycerin patches on the affected limb. Complete resolution of symptoms and arteriography findings occurred 2 days after therapy began.
Asunto(s)
Fármacos Anti-VIH/efectos adversos , Inhibidores del Citocromo P-450 CYP3A/efectos adversos , Ergotamina/efectos adversos , Ergotismo/etiología , Infecciones por VIH/tratamiento farmacológico , Cefalea/tratamiento farmacológico , Isquemia/inducido químicamente , Ritonavir/efectos adversos , Saquinavir/efectos adversos , Vasoconstrictores/efectos adversos , Adulto , Fármacos Anti-VIH/uso terapéutico , Anticoagulantes/uso terapéutico , Cilostazol , Didesoxinucleósidos/uso terapéutico , Combinación de Medicamentos , Interacciones Farmacológicas , Enoxaparina/uso terapéutico , Ergotismo/tratamiento farmacológico , Humanos , Isquemia/diagnóstico , Isquemia/tratamiento farmacológico , Lamivudine/uso terapéutico , Extremidad Inferior/irrigación sanguínea , Masculino , Nitroglicerina/uso terapéutico , Tetrazoles/uso terapéutico , Arterias Tibiales/diagnóstico por imagen , Ultrasonografía Doppler en Color , Vasodilatadores/uso terapéuticoRESUMEN
Ergotism is the long-term ergot poisoning by ingestion of rye or other grains infected with the fungus Claviceps purpurea and more recently by excessive intake of ergot drugs. It has either neuropsychiatric or vascular manifestations. In the Middle Ages, the gangrenous poisoning was known as St. Anthony's fire, after the order of the Monks of St. Anthony who were particularly skilled at treating the condition. In 1917, Prof. Arthur Stoll returned home to Switzerland from Germany, to lead the development of a new pharmaceutical department at Sandoz Chemical Company. Stoll, using the special methods of extraction learned from his work with his mentor Willstetter, started his industrial research work with ergot. He succeeded in isolating, from the ergot of rye, ergotamine as an active principle of an old popular remedy for excessive post-partum bleeding. The success of this discovery occurred in 1918 and was translated into a pharmaceutical product in 1921 under the trade name Gynergen. In subsequent work, Stoll and his team were leaders in identifying the structure of the many other alkaloids and amines produced by Claviceps purpurea This was the cultural background and scientific foundation on which bromocriptine was discovered.
Asunto(s)
Antiparkinsonianos/uso terapéutico , Bromocriptina/uso terapéutico , Agonistas de Dopamina/uso terapéutico , Descubrimiento de Drogas/historia , Enfermedad de Parkinson/tratamiento farmacológico , Acromegalia/tratamiento farmacológico , Acromegalia/historia , Animales , Aniversarios y Eventos Especiales , Antiparkinsonianos/historia , Antiparkinsonianos/aislamiento & purificación , Antiparkinsonianos/envenenamiento , Bromocriptina/aislamiento & purificación , Bromocriptina/metabolismo , Bromocriptina/envenenamiento , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/historia , Agonistas de Dopamina/historia , Agonistas de Dopamina/aislamiento & purificación , Agonistas de Dopamina/envenenamiento , Quimioterapia Combinada/efectos adversos , Quimioterapia Combinada/historia , Ergotismo/etiología , Ergotismo/historia , Historia del Siglo XX , Antagonistas de Hormonas/efectos adversos , Antagonistas de Hormonas/historia , Antagonistas de Hormonas/uso terapéutico , Humanos , Hiperprolactinemia/tratamiento farmacológico , Hiperprolactinemia/historia , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/historia , Hipoglucemiantes/uso terapéutico , Enfermedad de Parkinson/historia , Neoplasias Hipofisarias/tratamiento farmacológico , Neoplasias Hipofisarias/historiaRESUMEN
High activity antiretroviral therapy may exacerbate the activity of ergot alkaloids due to an inhibition of cytochrome P450. We report a 57 years old female with AIDS treated with lamivudine, zidovudine, atazanavir, ritonavir and cotrimoxazole presenting with ischemic signs in the four limbs. There was acrocyanosis and weak radial and ulnar pulses. A family member referred that the patient used ergot alkaloids for headaches. An ergotism due to the simultaneous use of ergot alkaloids and antiretroviral therapy was suspected. The latter was discontinued and intravenous nitroglycerin, nifedipine and pentoxifyline were started with good results.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Alcaloides de Claviceps/efectos adversos , Ergotismo/etiología , Ergotismo/diagnóstico , Ergotismo/terapia , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Persona de Mediana EdadRESUMEN
High activity antiretroviral therapy may exacerbate the activity of ergot alkaloids due to an inhibition of cytochrome P450. We report a 57 years old female with AIDS treated with lamivudine, zidovudine, atazanavir, ritonavir and cotrimoxazole presenting with ischemic signs in the four limbs. There was acrocyanosis and weak radial and ulnar pulses. A family member referred that the patient used ergot alkaloids for headaches. An ergotism due to the simultaneous use of ergot alkaloids and antiretroviral therapy was suspected. The latter was discontinued and intravenous nitroglycerin, nifedipine and pentoxifyline were started with good results.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Ergotismo/etiología , Terapia Antirretroviral Altamente Activa , Alcaloides de Claviceps/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Ergotismo/diagnóstico , Ergotismo/terapiaRESUMEN
Consumption of feedstuffs contaminated with ergot alkaloids has a broad impact on many different physiological mechanisms that alters the homeostasis of livestock. This change in homeostasis causes an increased sensitivity in livestock to perturbations in the ambient environment, resulting in an increased sensitivity to such stressors. This ultimately results in large financial losses in the form of production losses to livestock producers around the world. This review will focus on the underlying physiological mechanisms that are affected by ergot alkaloids that lead to decreases in livestock production.
Asunto(s)
Alcaloides de Claviceps/toxicidad , Ganado/fisiología , Alimentación Animal , Animales , Ergotismo/etiología , Contaminación de Alimentos , Humanos , Lipomatosis/etiologíaRESUMEN
Clinical ergotism is a rare disorder, and clinical and therapeutic implications have continued to attract attention. The Holy Fire or St. Anthony's Fire was the primary vascular manifestation, causing burning pain and gangrene in the feet and hands related to the arterial spasm properties of ergot. The chronic use of ergotamine and migraine has also been associated with ergotism. Severe vasospasm and acute peripheral ischemia of the extremities can develop. However, in modern times, the spectrum of poisoning by alkaloids has broadened to include antiviral therapies in patients with HIV and abuse of stimulants. These changes have made taking an accurate medical history and conducting an accurate detailed differential diagnosis more essential. The purpose of this review is to highlight the importance of ergotism as a cause of peripheral vascular ischemia and analyze changes associated with this poisoning.
Asunto(s)
Ergotismo , Isquemia , Antivirales/efectos adversos , Estimulantes del Sistema Nervioso Central/efectos adversos , Ergotamina/efectos adversos , Ergotismo/diagnóstico , Ergotismo/etiología , Ergotismo/fisiopatología , Ergotismo/terapia , Humanos , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/fisiopatología , Isquemia/terapia , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Trastornos Relacionados con Sustancias/complicaciones , Vasoconstrictores/efectos adversosRESUMEN
Ergotism is a complication of acute intoxication and/or chronic abuse of ergot derivatives. It expresses itself through a vasomotor syndrome with peripheral vascular disease which frequently involves extremities. We report four cases of HIV-1 infected patients treated with antiretroviral drugs including boosted-protease inhibitors who had self-treated themselves with ergotamine. They developed peripheral vascular disease symptoms and their pulses where diminished or absent in the physical examination. Arterial Doppler confirmed diffused arterial spasm in two of them. Ergotism following ergotamine-protease inhibitors association was diagnosed. Patients were treated through the discontinuity of involved drugs (protease inhibitors and ergotamine), calcium blockers; antithrombotic prophylaxis with enoxaparine, antiaggregant therapy with acetylsalicylic acid, and one of them received pentoxifylline and vasodilator prostaglandins infusion, with amelioration of the symptoms. We discuss the clinical presentation of this drug interaction, difficult to diagnose properly without a strong suspicion of its existence.
Asunto(s)
Agonistas de Receptores Adrenérgicos alfa 1/efectos adversos , Ergotamina/efectos adversos , Ergotismo/etiología , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Ritonavir/efectos adversos , Adulto , Interacciones Farmacológicas , Quimioterapia Combinada/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
El ergotismo es una complicación de la intoxicación aguda y/o el abuso crónico de los derivados del ergot. Se manifiesta por síndrome vasomotor con enfermedad vascular periférica que frecuentemente compromete extremidades. Presentamos cuatro casos de pacientes infectados con el virus de la inmunodeficiencia humana 1 (HIV-1), en tratamiento con antirretrovirales que incluyen inhibidores de la proteasa reforzados con ritonavir, y que habían recibido ergotamina como automedicación. Ellos desarrollaron síntomas de enfermedad vascular periférica y al examen físico sus pulsos estaban disminuidos o ausentes. El Doppler arterial confirmó signos de espasmo arterial difuso en dos de ellos. Se hizo diagnóstico de ergotismo secundario a la asociación de ergotamina-inhibidores de la proteasa. Los pacientes fueron tratados con la discontinuación de las drogas involucradas (inhibidores de la proteasa y ergotamina), bloqueantes cálcicos, profilaxis antitrombótica con enoxaparina, antiagregación con ácido acetil salicílico y uno ellos recibió pentoxifilina e infusión de prostaglandinas vasodilatadoras con mejoría de los síntomas. Discutimos la presentación clínica de esta interacción medicamentosa, difícil de diagnosticar correctamente sin una fuerte sospecha de su existencia.(AU)
Ergotism is a complication of acute intoxication and/or chronic abuse of ergot derivatives. It expresses itself through a vasomotor syndrome with peripheral vascular disease which frequently involves extremities. We report four cases of HIV-1 infected patients treated with antiretroviral drugs including boosted-protease inhibitors who had self-treated themselves with ergotamine. They developed peripheral vascular disease symptoms and their pulses where diminished or absent in the physical examination. Arterial Doppler confirmed diffused arterial spasm in two of them. Ergotism following ergotamine-protease inhibitors association was diagnosed. Patients were treated through the discontinuity of involved drugs (protease inhibitors and ergotamine), calcium blockers; antithrombotic prophylaxis with enoxaparine, antiaggregant therapy with acetylsalicylic acid, and one of them received pentoxifylline and vasodilator prostaglandins infusion, with amelioration of the symptoms. We discuss the clinical presentation of this drug interaction, difficult to diagnose properly without a strong suspicion of its existence.(AU)
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agonistas de Receptores Adrenérgicos alfa 1/efectos adversos , Ergotamina/efectos adversos , Ergotismo/etiología , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Ritonavir/efectos adversos , Interacciones Farmacológicas , Quimioterapia Combinada/efectos adversosRESUMEN
El ergotismo es una complicación de la intoxicación aguda y/o el abuso crónico de los derivados del ergot. Se manifiesta por síndrome vasomotor con enfermedad vascular periférica que frecuentemente compromete extremidades. Presentamos cuatro casos de pacientes infectados con el virus de la inmunodeficiencia humana 1 (HIV-1), en tratamiento con antirretrovirales que incluyen inhibidores de la proteasa reforzados con ritonavir, y que habían recibido ergotamina como automedicación. Ellos desarrollaron síntomas de enfermedad vascular periférica y al examen físico sus pulsos estaban disminuidos o ausentes. El Doppler arterial confirmó signos de espasmo arterial difuso en dos de ellos. Se hizo diagnóstico de ergotismo secundario a la asociación de ergotamina-inhibidores de la proteasa. Los pacientes fueron tratados con la discontinuación de las drogas involucradas (inhibidores de la proteasa y ergotamina), bloqueantes cálcicos, profilaxis antitrombótica con enoxaparina, antiagregación con ácido acetil salicílico y uno ellos recibió pentoxifilina e infusión de prostaglandinas vasodilatadoras con mejoría de los síntomas. Discutimos la presentación clínica de esta interacción medicamentosa, difícil de diagnosticar correctamente sin una fuerte sospecha de su existencia.
Ergotism is a complication of acute intoxication and/or chronic abuse of ergot derivatives. It expresses itself through a vasomotor syndrome with peripheral vascular disease which frequently involves extremities. We report four cases of HIV-1 infected patients treated with antiretroviral drugs including boosted-protease inhibitors who had self-treated themselves with ergotamine. They developed peripheral vascular disease symptoms and their pulses where diminished or absent in the physical examination. Arterial Doppler confirmed diffused arterial spasm in two of them. Ergotism following ergotamine-protease inhibitors association was diagnosed. Patients were treated through the discontinuity of involved drugs (protease inhibitors and ergotamine), calcium blockers; antithrombotic prophylaxis with enoxaparine, antiaggregant therapy with acetylsalicylic acid, and one of them received pentoxifylline and vasodilator prostaglandins infusion, with amelioration of the symptoms. We discuss the clinical presentation of this drug interaction, difficult to diagnose properly without a strong suspicion of its existence.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agonistas de Receptores Adrenérgicos alfa 1/efectos adversos , Ergotamina/efectos adversos , Ergotismo/etiología , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Ritonavir/efectos adversos , Interacciones Farmacológicas , Quimioterapia Combinada/efectos adversosRESUMEN
Ergotism is a complication of acute intoxication and/or chronic abuse of ergot derivatives. It expresses itself through a vasomotor syndrome with peripheral vascular disease which frequently involves extremities. We report four cases of HIV-1 infected patients treated with antiretroviral drugs including boosted-protease inhibitors who had self-treated themselves with ergotamine. They developed peripheral vascular disease symptoms and their pulses where diminished or absent in the physical examination. Arterial Doppler confirmed diffused arterial spasm in two of them. Ergotism following ergotamine-protease inhibitors association was diagnosed. Patients were treated through the discontinuity of involved drugs (protease inhibitors and ergotamine), calcium blockers; antithrombotic prophylaxis with enoxaparine, antiaggregant therapy with acetylsalicylic acid, and one of them received pentoxifylline and vasodilator prostaglandins infusion, with amelioration of the symptoms. We discuss the clinical presentation of this drug interaction, difficult to diagnose properly without a strong suspicion of its existence.
Asunto(s)
Agonistas de Receptores Adrenérgicos alfa 1/efectos adversos , Ergotamina/efectos adversos , Ergotismo/etiología , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Ritonavir/efectos adversos , Adulto , Interacciones Farmacológicas , Quimioterapia Combinada/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Ergotism is a clinical condition known since old times and whose main characteristics are ischemia and even limb gangrene. Some drugs have the capacity of interacting with small amounts of ergotamine or its derivatives producing ergotism as a side effect. This is the case of ritonavir, a widely used anti-HIV drug. Here we present a case of ergotism that developed in an HIV positive 39 year old male under treatment with ritonavir, after taking 1 mg of ergotamine tartrate. His clinical picture, apart from showing the basic manifestations of the disease, was associated with splenic infarction. For this reason, we consider important to advise patients about the potential pharmacological interaction between ergotamines and others common drugs and, in particular, ritonavir in HIV positive patients.
Asunto(s)
Ergotamina/efectos adversos , Ergotismo/etiología , Inhibidores de la Proteasa del VIH/efectos adversos , Ritonavir/efectos adversos , Infarto del Bazo/inducido químicamente , Vasoconstrictores/efectos adversos , Adulto , Interacciones Farmacológicas , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
El ergotismo es una enfermedad conocida desde la antig³edad, que se caracteriza por isquemia y, en algunos casos, gangrena de las extremidades. Muchas drogas de uso corriente tienen la capacidad de interactuar con los ergotamínicos desarrollando ergotismo como efecto adverso. Un ejemplo de ello es el ritonavir, un inhibidor de la proteasa utilizado en pacientes con el virus de la inmunodeficiencia humana (HIV). Presentamos un caso de ergotismo en un varón de 39 años con infección por HIV en tratamiento con ritonavir que, después de ingerir 1 mg de tartrato de ergotamina, además de presentar manifestaciones clásicas de la enfermedad, desarrolló un infarto esplénico. Por lo tanto, consideramos importante advertir a los pacientes sobre la posible interacción farmacológica entre los ergotamínicos y otras drogas de uso frecuente y, en particular, el ritonavir en pacientes portadores de HIV.(AU)
Ergotism is a clinical condition known since old times and whose main characteristics are ischemia and even limb gangrene. Some drugs have the capacity of interacting with small amounts of ergotamine or its derivatives producing ergotism as a side effect. This is the case of ritonavir, a widely used anti-HIV drug. Here we present a case of ergotism that developed in an HIV positive 39 year old male under treatment with ritonavir, after taking 1 mg of ergotamine tartrate. His clinical picture, apart from showing the basic manifestations of the disease, was associated with splenic infarction. For this reason, we consider important to advise patients about the potential pharmacological interaction between ergotamines and others common drugs and, in particular, ritonavir in HIV positive patients.(AU)
Asunto(s)
Adulto , Humanos , Masculino , Ergotamina/efectos adversos , Ergotismo/etiología , Inhibidores de la Proteasa del VIH/efectos adversos , Ritonavir/efectos adversos , Infarto del Bazo/inducido químicamente , Vasoconstrictores/efectos adversos , Interacciones Farmacológicas , Infecciones por VIH/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
El ergotismo es una enfermedad conocida desde la antigüedad, que se caracteriza por isquemia y, en algunos casos, gangrena de las extremidades. Muchas drogas de uso corriente tienen la capacidad de interactuar con los ergotamínicos desarrollando ergotismo como efecto adverso. Un ejemplo de ello es el ritonavir, un inhibidor de la proteasa utilizado en pacientes con el virus de la inmunodeficiencia humana (HIV). Presentamos un caso de ergotismo en un varón de 39 años con infección por HIV en tratamiento con ritonavir que, después de ingerir 1 mg de tartrato de ergotamina, además de presentar manifestaciones clásicas de la enfermedad, desarrolló un infarto esplénico. Por lo tanto, consideramos importante advertir a los pacientes sobre la posible interacción farmacológica entre los ergotamínicos y otras drogas de uso frecuente y, en particular, el ritonavir en pacientes portadores de HIV.
Ergotism is a clinical condition known since old times and whose main characteristics are ischemia and even limb gangrene. Some drugs have the capacity of interacting with small amounts of ergotamine or its derivatives producing ergotism as a side effect. This is the case of ritonavir, a widely used anti-HIV drug. Here we present a case of ergotism that developed in an HIV positive 39 year old male under treatment with ritonavir, after taking 1 mg of ergotamine tartrate. His clinical picture, apart from showing the basic manifestations of the disease, was associated with splenic infarction. For this reason, we consider important to advise patients about the potential pharmacological interaction between ergotamines and others common drugs and, in particular, ritonavir in HIV positive patients.
Asunto(s)
Adulto , Humanos , Masculino , Ergotamina/efectos adversos , Ergotismo/etiología , Inhibidores de la Proteasa del VIH/efectos adversos , Ritonavir/efectos adversos , Infarto del Bazo/inducido químicamente , Vasoconstrictores/efectos adversos , Interacciones Farmacológicas , Infecciones por VIH/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
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.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ergotamina/envenenamiento , Ergotismo/etiología , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Enfermedad Arterial Periférica/inducido químicamente , Ritonavir/efectos adversos , Interacciones Farmacológicas , Quimioterapia Combinada/efectos adversos , Vasoconstrictores/envenenamientoRESUMEN
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.