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

Abstract

Terlipressin is used for the treatment of bleeding oesophageal varices and hepatorenal syndrome in patients with cirrhosis. Adverse effects are usually minimal. However, potentially serious side effects such as skin necrosis involving the extremities, scrotum, trunk and abdominal skin can rarely occur. Our patient had greater skin involvement than other described cases. We present the case of a patient with extensive skin necrosis, unrelated to the infusion site, in the lower and upper limbs, scrotum and abdomen after the use of terlipressin. Skin necrosis secondary to terlipressin is a rare complication and early identification is essential so the drug can be immediately suspended.LEARNING POINTSSkin necrosis secondary to terlipressin is a rare complication.Early identification is essential so the drug can be immediately suspended.Death is not directly related to the skin necrosis but to the secondary complications of advanced liver disease.

Management of hepatic hydropericardium with open drainage, maximal medical therapy and terlipressin

“…Meanwhile, Saner et al treated hepatorenal syndrome and ascites with terlipressin and hydroxyethyl starch in a post-hemihepatectomy patient 14. While terlipressin is relatively safe compared with other vasoconstrictors, its rare adverse effects can be severe, including ischaemic skin necrosis,15–18 cardiac arrhythmias19 and hyponatraemia 20–22. These side effects could be dose dependent as they mostly develop days after treatment commencement.…”

Terlipressin-Induced Skin Necrosis While Managing Hepatorenal Syndrome: A Rare Case Report From North India

“…Terlipressin is a well-established drug used in the treatment of bleeding esophageal varices and hepatorenal syndrome [ 4 ] associated with liver cirrhosis. Despite its effectiveness, it has been reported to have some adverse effects, including ischemic necrosis, predominantly skin affecting skin over the abdomen, torso, scrotal area, upper and lower extremities [ 5 ]. In this case, we present a rare instance where a 48-year-old male patient developed skin necrosis in bilateral lower extremities after administration of terlipressin while managing hepatorenal syndrome.…”

A critical review on the recent developments on hepatorenal syndrome

“…Ischemic side effects includes ischemic skin necrosis, coronary artery ischemia, bowel necrosis, myocardial infarction. Ischemic skin necrosis is usually characterized by cyanosis of upper and lower extremities including fingers and toes [35,36] . Management of ischemic side effects usually involves drug withdrawal, thereby leading to a high mortality rate.…”

“…Management of ischemic side effects usually involves drug withdrawal, thereby leading to a high mortality rate. Most common side-effects include pallor, headache, side effects, hypertension, bradycardia [36] .…”