Cutaneous Ischaemia Following Terlipressin Therapy for Hepatorenal Syndrome

Basheer, Aneesh; Yoganandan, Dayanandan; John, M. B.; Guna, Prem Kumar

doi:10.7860/jcdr/2018/30817.11281

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“…Currently, the administration of a vasoconstrictor plus albumin is the most common approach in patients with HRS as this approach has been proven to be effective in the treatment of HRS among patients with cirrhosis and ascites [4,5]. Although terlipressin has an acceptable side effect profile when compared with the profile of vasopressin, there have been case reports on ischemic side effects associated with terlipressin administration, including skin ischemia [6,7], ventricular dysfunction [8], peripheral gangrene [9], ischemic necrosis [10,11], and acute myocardial infarction [12]. Here, we report a case of extensive peripheral cyanosis involving the fingers, toes, area around an umbilical hernia, and scrotum following terlipressin administration in a cirrhotic patient with HRS.…”

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confidence: 99%

Terlipressin-Induced Peripheral Cyanosis in a Patient with Liver Cirrhosis and Hepatorenal Syndrome

2019

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Patient: Male, 65Final Diagnosis: Terlipressin-induced peripheral cyanosisSymptoms: Cold extremitiesMedication: TerlipressinClinical Procedure: Terlipressin administration was discontinuedSpecialty: Gastroenterology and HepatologyObjective:Challenging differential diagnosisBackground:Hepatorenal syndrome (HRS), which is a type of functional renal impairment, is one of the most serious complications in patients with liver cirrhosis. Terlipressin can induce splanchnic vasoconstriction, which increases the renal blood flow and has beneficial effects on HRS. However, terlipressin administration may cause serious ischemic complications such as skin ischemia, peripheral gangrene, and ischemic bowel necrosis. Here, we report a case of peripheral cyanosis following terlipressin administration in a cirrhotic patient with HRS.Case Report:The patient was a 65-year-old male. He was considered to have type-1 HRS, and thus, terlipressin was administered. However, peripheral cyanosis involving the fingers, toes, area around an umbilical hernia, and scrotum was noted. Thus, terlipressin administration was discontinued. Subsequently, his condition rapidly improved.Conclusions:We reported a case of peripheral cyanosis following terlipressin administration, which resolved after discontinuation of terlipressin administration. It is important to recognize the early signs of side effects and discontinue the administration of the suspected drug immediately.

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