[Ergotism due to simultaneous use of ergot alkaloids and high activity antiretroviral therapy]. / Ergotismo por uso simultáneo de ergotamínico y terapia antirretroviral: Report of one case.

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.

Análisis de la enfermedad dermatológica en 8 Cantigas de Santa María del Rey Alfonso X el Sabio. Parte I: introducción, el monje resucitado «lac virginis», el ergotismo y la lepra / Dermatologic Diseases in 8 of the Cantigas of Holy Mary of Alfonso X the Learned - Part 1: Introduction, the Monk Revived by the Virgin's Milk, Ergotism, and Leprosy

No disponible

Ergotismo por uso simultáneo de ergotamínico y terapia antirretroviral: Report of one case / Ergotism due to simultaneous use of ergot alkaloids and high activity antiretroviral therapy

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.

Ergotism and factitious hypotension associated with interaction of ergotamine with CYP3A4 inhibitors.

BACKGROUND: Although uncommon, severe ergotism continues to occur. The purpose of this study is to describe causes and clinical effects of ergotism in recent years. METHODS: This is an observational case series with data obtained retrospectively from all patients with ergotism referred to Ramathibodi Poison Center in Bangkok, Thailand from January 2006 to August 2013. RESULT: Twelve cases of ergotism were identified. All cases involved ergotamine 1 mg/caffeine 100 mg combination tablets. Nine cases (75%) were precipitated by drug-drug interactions with CYP3A4 inhibitors. The other cases involved suicidal attempt (2 cases) and pediatric unsupervised ingestion (1 case). Ten patients (83%) had signs of peripheral vascular insufficiency. Five of these patients initially had factitiously low or unmeasurable blood pressure using non-invasive technique and had paradoxical increase following intravenous vasodilator administration. Two patients required partial foot amputations due to gangrene. Two patients, including a 15-month-old boy with an unsupervised ingestion, died. DISCUSSION: In this series, most cases of severe ergotism were associated with interaction with CYP3A4 inhibitors, which increase ergotamine bioavailability. Factitious low blood pressure in these cases was likely caused by severe vasospasm. CONCLUSION: Critical ergotism continues to occur in Thailand, most commonly associated with the drug-drug interactions.

Ergotism: a change of persepective.

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.

[Petit-Saint-Antoine, Parisian hospice for the treatment of ergotism from the 11th to the 16th Century]. / Le Petit-Saint-Antoine, hospice parisien soignant le mal des ardents du XIème au XVIème siècle.

Petit-Saint-Antoine was for six centuries a Parisian hospital specialized in the treatment of the so-called "mal des ardents", or ergotism.

Acute limb ischemia due to ergotism.

Acute ischemia of an extremity potentially threatens limb loss and occasionally the life of the patient. We are reporting two cases of extremity ischemia secondary to ergot poisoning. The first patient was a 60 years old woman, who presented with a 15 days history of ischemia of the left arm with gangrene of the fingers and pain in the resting right hand for one day. Right brachial artery catheterization showed severe spasm of the artery which was resolved by passage of the inflated balloon catheter. She underwent amputation for gangrene of the left hand. The second patient presented with bilateral symmetrical ischemia of the lower extremities which improved upon withdrawal of the ergot containing medicine. She responded to nifedipine.

Methylergometrine poisoning in children: review of 34 cases.

Methylergometrine is often used in the management of the third stage of labor and for treatment of prevention of puerperal hemorrhage. Intoxication in newborns is rare but may lead to severe complications. We reviewed 34 cases of methylergometrine poisoning that occurred in Belgium between 1969 and 1999. Fourteen patients were newborns and 20 were older children. Twenty-nine patients were exposed by the oral route, 3 by the intranasal route, and 2 by the intramuscular route. Oral exposure was associated mostly with gastrointestinal symptoms, but one newborn required mechanical ventilation for apnea. Intramuscular exposure was associated with severe complications, including apnea, coma, and convulsions. We describe the first case of oral methylergometrine poisoning requiring mechanical ventilation and alert physicians that oral exposure to methylergometrine may lead to severe complications.

Ergotismo: ¿iatrogenia o idiosincrasia? / Ergotism: Iatrogenic or idiosyncrasy?

El ergotismo continúa siendo una causa rara de insuficiencia arterial crónica y aguda en pacientes en edad productiva, que si no es detectada y tratada a tiempo puede causar daño neurológico permanente o pérdida de la extremidad y como consecuencia invalidez del paciente. En un lapso de dos años se recibieron en el servicio cuatro pacientes con diagnóstico de ergotismo, tres mujeres y un hombre, se manejaron con interrupción de la ergotamina, vasodilatadores y dos de ellos con simpatectomía lumbar; dos de los pacientes presentaron secuelas y determinar si el ergotismo es una iatrogenia causada por el uso prolongado de este medicamento

Ergotism and vascular insufficiency: a case report and review of literature.

We report a case of ergot-induced peripheral vascular insufficiency of the lower limbs and review the vascular complications, angiographic findings and the different modalities of treatment. The following case report highlights the clinical features and course of ergot toxicity, and the difficulty in early diagnosis.

[Vascular ergotism through inhalation of grain dust]. / Vaskulärer Ergotismus durch Getreidestaubinhalation.

HISTORY AND CLINICAL FINDINGS: For 6 months a 42-year-old farmer without cardiovascular risk factors had been suffering from increasing pain in both feet and calves. Angiography two months apart had demonstrated progressive narrowing of all lower-leg arteries. Pain-free walking had become restricted to 50 m, there were no palpable pulses in the right foot and those in the left foot were markedly reduced. INVESTIGATIONS: Occlusion pressure of the right foot was 55 mm Hg. Repeat angiography showed proximal occlusion of all three lower-leg arteries. Biopsy and biochemical tests excluded degenerative and inflammatory causes of the vascular disease. DIAGNOSIS, TREATMENT AND COURSE: Enquiry of the patient discovered that he had been exposed to ergotamine-containing milling dust in the preparation of rye flour. Inhalational intake of ergotamine was proven by a high plasma ergotamine level. Attempted treatment with prostaglandin E1 (intraarterially for 16 days), doxazosin (2 mg/d) and acetylsalicylic acid 300 mg/d) had only little effect on symptoms. But complete avoidance of exposure to flour dust slowly decreased the plasma level of ergotamine within 4 months, after which all lower-leg arteries had almost completely re-opened. CONCLUSIONS: This is the first reported case proving that chronic ergotamine inhalation can cause ergotism affecting peripheral arteries. As the plasma ergotamine level fell only slowly it must be assumed that ergotamine had accumulated in a, so far unknown, body depot with slow release into the blood.

Ergotismo: diagnóstico y tratamiento. Revisión de la literatura e informe de un caso clínico / Diagnosis and treatment of ergotism in a patient. Review of the literature and a clinical case report

Presentamos la historia clínica de un paciente del sexo masculino de 53 años con datos francos de isquemia en extremidades asociado con el consumo de antimigrañosos. Con el tratamiento médico desaparecen los sintomas y signos de isquemia. Demostramos como método diagnóstico la arteriografía previa y de control, los hallazgos característicos descritos en la literatura, así como el uso de ultrasonido Doppler color, no descrito con anterioridad

Equine fescue toxicosis: signs and solutions.

Gravid mares grazing endophyte-infested (E+) tall fescue exhibit increased gestation lengths, agalactia, foal and mare mortality, tough and thickened placentas, weak and dysmature foals, increased sweating during warm weather, reduced serum prolactin and progesterone, and increased serum estradiol-17 beta levels. Also, E+ tall fescue hay is less digestible than endophyte-free (E-) hay. Unlike many other species, horses consuming E+ tall fescue do not exhibit increased body temperature. Young horses consuming only E+ pasture do not gain as well as those consuming E- pasture. There is little difference in gain when the pasture is supplemented with enough concentrate to meet NRC requirements for growth. Neither selenium injections nor supplementing with corn at 50% of the NRC requirements for energy reduces the effects of toxic tall fescue on reproduction and lactation in gravid mares. It seems that the alkaloids of E+ tall fescue are serving as D2 dopamine receptor agonists. This activity would explain their prolactin-lowering effect. Domperidone, a dopamine receptor antagonist, is effective in preventing the signs of tall fescue toxicosis in horses without neuroleptic side effects.

[Ergotism and ischemia of the limbs]. / Ergotisme et ischémie des membres.

Clinical ergotism as seen today results almost exclusively from the intake of ergotamine tartrate in the treatment of migraine headache. Vasospasm of peripheral arteries is the leading clinical picture. Besides the formation of collaterals and a secondary thrombosis, the vasospasm is one of the specific findings in arteriography. Early diagnosis and withdrawal of the medication makes complete restitution possible. In all other cases intraarterial or intravenous infusion of sodium nitroprusside has turned out to be the most effective therapy. Balloon dilatation or operative intervention are an alternative therapy in those cases, where amputation of the limbs seems to be necessary.

[Ergotism of the locomotor apparatus--a sometimes forgotten diagnosis?]. / Das Krankheitsbild des Ergotismus am Bewegungsapparat--eine gelegentlich vergessene Diagnose?

The alcaloids from rye-ergot are known and used for their vasoconstrictive properties, which can induce secondary ergotism. The extremities will be particularly involved. Vasoconstriction will also concern the gastrointestinal tract as well as the peripheric and the central nervous system, possibly with neuro-psychiatry symptoms. Cardiac and renal involvement has been described. Migraine, thrombosis prophylaxis and obstetrical situations are the most frequent therapeutic indications. Precise patient history, clinical and the typical angiological findings are necessary for diagnosis. The importance of an early diagnosis is emphasized. The responsible agent can then be stopped with thorough in-time vasodilatating treatment, and restitution will occur. Three cases are reported. The patients were referred to the rheumato-orthopedic clinic because of limbs claims. They suffered from different grades of ergotism, and one had to be amputated at the right hand. The following discussion is based on a review of the literature.

St. Anthony's fire: successful reversal of ergotamine-induced peripheral vasospasm by hydrostatic dilatation.

A 60-year-old trauma victim developed severe ischemia of all four extremities following administration of heparin-dihydroergotamine as prophylaxis against deep venous thrombosis. Despite cessation of heparin-dihydroergotamine and infusion of intraarterial papaverine into the right femoral artery, both lower extremities progressed to frank gangrene and amputation (above-knee on the left and below-knee on the right). However, both ischemic upper extremities were salvaged following intraoperative hydrostatic dilatation with balloon catheters. Ergotism is an avoidable and potentially treatable cause of peripheral gangrene in the critically-ill patient.