Cutaneous Pseudolymphoma As a Rare Adverse Effect of Medicinal Leech Therapy: A Case Report and Review of the Literature

Sepaskhah, Mozhdeh; Yazdanpanah, Nazafarin; Aslani, Fatemeh Sari; Akbarzadeh‐Jahromi, Mojgan

doi:10.7759/cureus.7517

Cited by 7 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other complications of leech therapy include psychological effect, 12 lymphoid hyperplasia, 46,47 and the added complexity that farmed leeches may in fact be a different species than the presumed and literaturedefended Hirudo medicinalis. 48 Infection was also a potential adverse effect, however our patient was already on an antibiotic regimen that included meropenem to ensure coverage for Aeromonas, the leech gut flora most implicated in disease.…”

Section: Discussionmentioning

confidence: 99%

Hirudotherapy for neonatal limb ischemia during ECMO support: A word of caution

Resch

Said

Steiner

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Introduction: Disordered coagulation, clot formation and distal limb ischemia are complications of extracorporeal membrane oxygenation (ECMO) with significant morbidity and mortality. Medicinal leech therapy (hirudotherapy) has been attempted in plastic and orthopedic surgeries to improve venous congestion and salvage ischemic flaps. To our knowledge this has not been reported in pediatric cardiac surgery or during ECMO support. We present a complex neonate whose ECMO course was complicated by distal limb ischemia for whom leech therapy was attempted.Patient and Intervention: A 2-week-old 2.7 kg infant required ECMO support secondary to perioperative multiorgan system dysfunction following repair of critical coarctation and ventricular septal defect. Despite systemic anticoagulation, his clinical course was complicated by arterial thrombus, vasopressor-induced vascular spasm and bilateral distal limb ischemia. Medicinal leech therapy was tried after initially failing conventional measures.Result: Following the third leech application, this patient developed significant hemorrhage from the web space adjacent to the left great toe. An estimated 450 ml of blood loss occurred and more than 300 ml of blood product transfusions were required. He ultimately progressed to irreversible systemic end organ dysfunction and comfort care was provided. Conclusion:The use of medicinal leech therapy in pediatric cardiac surgery may be considered to minimize the consequences of advanced limb ischemia and venous congestion. However, this should be used with caution while patients are systemically anticoagulated during ECMO support. A directed review is presented here to assist in determining optimal application and potential course of therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Hirudotherapy for neonatal limb ischemia during ECMO support: A word of caution

Resch

Said

Steiner

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

show abstract

“…In dem vorliegenden Fall kam es zu einem Auftreten von Pseudolymphomen nach einer Behandlung mit medizinischen Blutegeln (Hirudotherapie). Bisher wurden nach bestem Wissen und Gewissen insgesamt nur 9 Fälle von kutanen PSL nach Hirudotherapie in der Literatur beschrieben [3][4][5][6][7][8][9][10][11], die in . Tab.…”

Section: Diskussionunclassified

“…(aktueller Fall) 76/w Unterer Rücken (lumbal), Ferse Gelenkschmerzen, Fersensporn Gemischt T‑ und B‑lymphozytäres Infiltrat Topische ST Langsam rückläufige Läsion Sepaskhah et al. (2020), [ 11 ] 44/w Schienbein Erythema nodosum Nicht durchgeführt Systemische ST Rückläufige Läsionen Topische ST Intraläsionale ST Sadati et al. (2019), [ 9 ] 45/w Untere Extremitäten Varikose und Schmerzen Nicht durchgeführt Topische ST Komplett rückläufige Läsionen Kryotherapie Temiz et al.…”

Section: Diskussionunclassified

Kutane Pseudolymphome nach Hirudotherapie

et al. 2021

View full text Add to dashboard Cite

ZusammenfassungUnter dem Begriff Pseudolymphom (PSL) versteht man eine benigne, reaktive Lymphoproliferation der Haut, die klinisch und/oder histologisch ein malignes Lymphom simulieren kann. Die genaue Ätiopathogenese ist bis heute nicht gänzlich geklärt. Man unterscheidet die primären, idiopathischen PSL ohne erkennbare Ursache von den sekundären PSL mit bekanntem Stimulus. Wir berichten über das Auftreten von Pseudolymphomen nach einer Behandlung mit medizinischen Blutegeln (Hirudotherapie). Bisher wurden nach bestem Wissen und Gewissen insgesamt nur 9 Fälle von kutanen PSL nach Hirudotherapie in der Literatur beschrieben.

show abstract

“…The pediatric critical care team at our institution has attempted to exploit this quality for treatment of refractory peripheral limb ischemia in select cases. No established guidance for this use exists, and the same salivary enzymes that dictate leech's therapeutic potential also predispose to adverse effects ( 2 , 27 – 33 ). We have previously reported a neonate requiring extracorporeal membrane oxygenation (ECMO) on whom hirudotherapy was attempted for limb ischemia, resulting in massive hemorrhage ( 34 ).…”

Section: Introductionmentioning

confidence: 99%

Hirudotherapy for limb ischemia in the pediatric intensive care unit: A retrospective observational cohort

et al. 2023

View full text Add to dashboard Cite

BackgroundAcute limb ischemia due to microvascular malperfusion may be refractory to initial therapies. Medicinal leech therapy (hirudotherapy) has been attempted in plastic and reconstructive surgery to improve venous congestion in ischemic flaps; however, there are minimal reports related to ischemia secondary to arterial malperfusion. We evaluated a pediatric cohort from an academic intensive care unit with refractory limb ischemia in whom hirudotherapy was attempted to elucidate its use and outcomes.MethodInstitutional patient database was queried to identify pediatric patients (<18 years) who received hirudotherapy in the pediatric critical care unit and met inclusion/exclusion criteria. Patient charts were evaluated for indices including demographics, primary disease, coagulative status, vascular access, vasoactive medication dosing, bleeding, leech use, limb and mortality outcomes. Data was evaluated to identify trends or suspected impact on outcomes.ResultsHirudotherapy was used in 7 patients for limb ischemia, 5 with congenital heart disease, and 2 others with viremic shock. Time to leech application following recognition of ischemia averaged 3 days, with duration of use averaging 3.9 days. Five patients discontinued therapy due to bleeding. Mortality rate was 57%, all secondary to multiorgan failure. In 3 surviving patients, 4 of 5 treated limbs resulted in at minimum partial amputation. Vasoactive-inotropic score tended higher prior to leech application, suggesting a vasoconstrictive pathway for arterial malperfusion. No identifiable trends appeared associated with salvaged limb or adverse effects. Blood loss predictably increased with leech application, as did total transfusion requirement.ConclusionThis case series establishes baseline data for use of hirudotherapy in critically ill children with acute limb ischemia caused by arterial malperfusion. Based on this retrospective cohort, we cannot recommend routine use of hirudotherapy for acute limb ischemia from arterial malperfusion in the pediatric intensive care unit. Application of leeches should be aligned with a protocol defining start and stop parameters, standardized leech utilization, and monitoring for adverse outcomes. Future study would benefit from consensus definitions of study outcomes, including perfusion recovery, tissue/limb salvage and bleeding manifestations. Additional prospective studies are needed prior to any standard or systematic recommendations for use.

show abstract

Cutaneous Pseudolymphoma As a Rare Adverse Effect of Medicinal Leech Therapy: A Case Report and Review of the Literature

Cited by 7 publications

References 11 publications

Hirudotherapy for neonatal limb ischemia during ECMO support: A word of caution

Hirudotherapy for neonatal limb ischemia during ECMO support: A word of caution

Kutane Pseudolymphome nach Hirudotherapie

Hirudotherapy for limb ischemia in the pediatric intensive care unit: A retrospective observational cohort

Contact Info

Product

Resources

About