Cutaneous Necrosis Secondary to Terlipressin Therapy

Posada, Celia; Feal, Carlos; A, Garcia-Cruz; Álvarez, Victoria; Álvarez, Mónica; Cruces, Manuel

doi:10.2340/00015555-0651

Cited by 14 publications

(7 citation statements)

References 8 publications

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“…Other study also reported that an increasing incidences of obesity and non-alcoholic fatty liver disease-related cirrhosis seemed to raise the ischemic complications of terlipressin 7. Obesity, venous insufficiency and spontaneous bacterial peritonitis were proposed as possible risk factors for the development of ischemic cutaneous complications 18. A recent report also proposed that obesity and hypovolemia be the risk factors associated with terlipressin-induced skin necrosis 8.…”

Section: Discussionmentioning

confidence: 99%

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

Lee

2013

Clin Mol Hepatol

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Variceal bleeding and hepatorenal syndrome (HRS) are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare) adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B) and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE) and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy.

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Section: Discussionmentioning

confidence: 99%

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

Lee

2013

Clin Mol Hepatol

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Terlipressin-induced ischaemic skin necrosis

et al. 2020

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Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.

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“…To our knowledge, only 11 cases including the present case have been reported to date (Table 1). Unlike DIC, which involves the distal extremities, terlipressin‐induced skin necrosis tends to affect the trunk and proximal limbs but not the fingers and toes 1–5 . Seven patients have received skin biopsy and five reports show ischemic skin necrosis.…”

Section: Comparison Of Clinical Manifestations In 10 Reported Cases mentioning

confidence: 99%

“…The condition may result from the unique distribution of vasopressin receptor type 1, which is located in areas of the body with large skin surface areas such as the thighs and abdomen 4 . Although the severity of skin ischemia is unassociated with terlipressin dosage, continuous infusion is reported as an additional risk 3,5 . However, only two of the reported cases received continuous administration of terlipressin.…”

Section: Comparison Of Clinical Manifestations In 10 Reported Cases mentioning

confidence: 99%

Terlipressin‐induced extensive skin necrosis: A case report and published work review

Wei

2012

The Journal of Dermatology

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Cutaneous Necrosis Secondary to Terlipressin Therapy

Cited by 14 publications

References 8 publications

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

Terlipressin-induced ischaemic skin necrosis

Terlipressin‐induced extensive skin necrosis: A case report and published work review

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