Cutaneous necrosis secondary to terlipressin therapy. A rare but serious side effect. Case report and literature review

Abstract

Terlipressin is a vasopressin analogue used in esophageal variceal bleeding and hepatorenal syndrome management. It is a safe drug with mild secondary effects. However, potentially serious ischemic complications may occur, such as cutaneous necrosis. It is useful to recognize these events early, in order to withdraw terlipressin and introduce other adjuvant drugs if needed. We report a detailed case of cutaneous necrosis secondary to terlipressin administration and present a case review of patients, describing their characteristics, risk factors, lesion locations, doses, methods of administration and possible treatments.

Terlipressin-induced ischaemic skin necrosis

“…However, there are case reports of terlipressin causing skin necrosis and gangrene (table 1). 4–22 Nineteen articles reporting a total of 25 patients were analysed. Of these patients, 80% were male and the mean age was 58.88±12.36 years.…”

Terlipressin-related Ischaemic Necrosis of the Skin: A Rare Complication

“…It has a half-life of approximately 6 hours [1] . This drug also has high affinity for type V1 receptors located in the smooth muscles of blood vessels mostly in the splenic, renal, myometrial, bladder, adipocyte and cutaneous circulations [1–3] . Its vasoconstrictor effect is similar to that of vasopressin but requires a lower dosage with fewer side effects.…”

“…The most common adverse effects are pallor, headache, abdominal pain, bradycardia and hypertension. There are more serious rare complications such as myocardial infarction, ischaemic colitis and skin necrosis [3] .…”

“…Reports in the literature generally describe one or two affected body areas such as the abdominal wall, thigh, leg, toes, tongue, scalp, scrotum, breast and oesophagus. Other areas less frequently affected are the feet, breasts, back, forearms (except the hands and fingers), scalp and tongue [3] . Our patient had greater skin involvement affecting the upper and lower limbs, scrotum and abdomen.…”

“…Macroscopically, the lesions are characteristically blackish in colour. Consequently, such lesions in a patient treated with terlipressin should raise immediate suspicion of this adverse effect [3] .…”