Ergot induced peripheral vascular insufficiency, non‐interventional treatment

Abstract

We report a case of ergotamine tartrate induced severe vasospasm in the renal arteries and the arteries of the lower extremities. Classic features seen on peripheral angiography make the diagnosis. Anticoagulation, thrombolysis, vasodilation, steroids, and prostaglandin inhibitors all have been successfully used to treat symptomatic ergot induced arterial vasospasm. Although balloon angioplasty of ergot induced vasospasm has been described in case reports, ergot vasospasm is a self limited and medically treatable condition that does not require peripheral mechanical intervention, unless the immediate threat of necrosis and gangrene exists.

Ergotamine-induced lower extremity arterial vasospasm presenting as acute limb ischemia

“…More recently, Baldwin and Ceraldi described a case of ergotamine toxicity in a human immunodeficiency virus infected patient treated with antiviral protease inhibitor (8). Ergotamine and propranolol may be synergistic for severe ischemic coronary vasospasm (3).…”

“…The need for arteriography and the course of treatment depend on the location and severity of symptoms (9). Occasionally, treatment includes vascular surgery, hyperbaric oxygen therapy, and peritoneal dialysis as needed (3).…”

“…Peripheral balloon angioplasty, atherectomy and other interventions may relieve the arterial spasm, but they increase the risk of permanent anatomic damage to otherwise normal arteries and, therefore, must be avoided when ergot toxicity is suspected, unless necrosis and gangrene are imminent (3).…”

“…Several agents, including erythromycin and tetracycline raise serum ergotamine levels and augment its effect (2). Because all these agents are used in certain patients, ergotamine-induced clinically significant vasoconstriction leading to vascular insufficiency can occur and should be suspected in certain patient populations (3).…”

Ergotamine-induced vasospastic ischemia mimicking arterial embolism: unusual case

“…Findings are generally symmetrical and show that both lower extremities are affected. [7] Since ergot intoxication is rare, these non-specific clinical findings are inadequate for diagnosis. In that context, radiological findings in combination with clinical findings and deep anamnesis become significant.…”