Nicorandil-associated perianal ulceration with prominent elastophagocytosis and flexural ulceration

Nicorandil-induced severe perianal ulceration

“…The mean time to healing was 5.9 months (range, [3][4][5][6][7][8][9][10][11][12]. The biopsies taken showed granulation and non-specific 344 inflammatory tissue.…”

“…It is the only drug in its class and powerful randomised controlled trials have demonstrated its effectiveness in reducing the incidence of death due to coronary heart disease, non-fatal myocardial infarction and unplanned hospitalisation due to cardiac chest pain [1]. The colorectal community is becoming increasingly aware of a subgroup of patients with anal ulceration and other gastrointestinal manifestations of nicorandil use [2][3][4][5][6]. We report our experience of 11 patients, emphasising the severe debilitating nature of the ulceration and the difficulty in diagnosis before recognising the association with nicorandil in this group of patients who inevitably have significant comorbidity.…”

Severe perianal ulceration

“…It can also occur as a reaction to the drug nicorandil, but our patient had never taken this drug. 4 In view of the history of lymphopenia and immunocompromise, the most likely diagnosis is HSV, which infects the skin and mucous membranes causing inflammation and damage to keratinocytes. HSV type 2 (HSV-2) is responsible for 70-90% of genital HSV infections, but an increasing proportion is now being caused by HSV-1, partly because of recent increases in the prevalence of unprotected oral sex.…”

“…Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: (1) No financial support for the submitted work from anyone other than their employer; (2) No financial relationships with commercial entities that might have an interest in the submitted work; (3) No spouses, partners, or children with relationships with commercial entities that might have an interest in the submitted work; (4) No non-financial interests that may be relevant to the submitted work.…”

Perianal ulceration and other cutaneous ulcerations complicating nicorandil therapy

“…[1][2][3][4][5] We have attended a total of 8 cases with possible nicorandil-induced perianal/ peristomal ulceration. An 82-year-old man presented in 2004 with a 3-year history of unexplained perianal ulcerations.…”