St. Anthony's Fire (Ergotamine Induced Leg Ischemia)

Abstract

Ergotism, once an epidemic disease, is now a rare disorder. The most common manifestation is acute peripheral ischemia due to vasospasm, with an incidence of 0.001%. We report a case of a middle-age woman who presented with ergotamine-induced leg ischemia, due to chronic use of ergotamine-containing medications for migraine headaches. The diagnosis was confirmed with arteriography results, and she responded well to vasodilator therapy. The pharmacology, clinical presentation, diagnostic approach, and therapy of ergotism are reviewed.

Ischemic Colitis Secondary to Ergotamine Use: A Case Study

“…Ergotamine is known to cause peripheral ischemia, as has been reported in several case studies, most commonly in the lower limbs [5, 6, 7, 8, 9]. Incidents of myocardial infarction [10] and stroke [11] have also been reported.…”

Drug-Drug Interaction of Ergotamine with a Combination of Darunavir, Abacavir, and Lamivudine Causing a Fatal Vasospastic Ischemia

“…Ergotism or ergotamine toxicity, denoted as ET, is an important and nowadays rare condition [1, 2]. Ergotamine mimics the neurotransmitters norepinephrine, serotonin, and dopamine and can result in smaller and bigger vessels vasospasm and vasoconstriction [3].…”

“…Symptoms of ET can be nausea, vomiting, abdominal pain, agitation, hallucinations, lethargy, confusion, painful spasms, seizures, feeble peripheral pulses and cyanotic limbs, loss of peripheral sensation, edema, and gangrene of affected tissues [4]. In some cases vasospasm can also occur in the blood vessels of the brain, kidney, eye, heart, and intestines [2]. If toxicity is left untreated or diagnosed late, it can eventually cause necrotising limbs leading to amputations [5], irreversible coma [6], or even possible dead [7].…”

“…The cause of ET is often ascribed to the ingestion of specific alkaloids (e.g., ergotamine and dihydroergotamine) produced by the Claviceps purpurea fungus as result of consumption of grain infested by fungi [2, 3, 8]. Furthermore it can also be induced after the administration of medication containing ergotamine [4, 7, 9].…”

“…Furthermore it can also be induced after the administration of medication containing ergotamine [4, 7, 9]. Even in therapeutic doses it can cause ET in susceptible individuals, for example, those with peripheral vascular disease, coronary artery disease, infection, or renal/hepatic impairment [1, 2, 5]. Moreover ET can be caused by accidental overdosing (> 0.25mg/kg) or by drug-drug interactions [4] including macrolide antibiotics [10], azole antifungals, HIV protease inhibitors, and some antidepressants [1, 6, 11].…”