RESUMO
HISTORY AND CLINICAL FINDINGS: A 42- year old women with a long history of migraine presented with burning pain of the limbs and reduced walking distance. No risk factors for peripheral arterial occlusive disease were present. Her daily medication included an ergotamine-containing-combination (2 mg ergotamine tartrate, 100 mg caffeine daily). INVESTIGATIONS: On examination both limbs were found to be cool and pulseless below the knee. The peripheral Doppler pressure indicated a bilaterally reduced ankle-brachial index. Color-coded duplex sonography showed constricted vessels and long stenosis with a decreased echo from the wall of the left and a distal occlusion of the right femoral artery without atherosclerotic changes. A diagnosis of ergotism was made and an arteriography was omitted because of the typical findings. TREATMENT AND COURSE: A detoxication treatment was initiated and optional intravenous prostaglandine E1 recommended if the condition did not improve. 23 days later the Doppler pressure and the Duplex sonography had become normal and showed spontaneous revascularization of the previously occluded right femoral artery, although collateral vessels were still detectable. CONCLUSION: Nowadays iatrogenic ergotism of the limbs is a rare diagnosis. An exact medical history and typical duplex sonographic findings confirm the diagnosis even if characteristic risk factors are missing. The first therapeutic measure in case of claudication is for ergotamine to be stopped. In case of critical ischaemia or gangrene immediate vasodilator therapy, e. g. with prostaglandine E1, is indicated.