Pericardial, retroperitoneal, and pleural fibrosis induced by pergolide

Abstract

Three patients with Parkinson's disease are described who developed pericardial, retroperitoneal, and pleural fibrosis associated with pergolide treatment. Surgical intervention was required in all three cases, either to reach a tissue diagnosis or for potentially life threatening complications. Symptoms emerged on average 2 years after the institution of treatment, and were suYciently non-specific to cause significant delays in diagnosis in all cases. The erythrocyte sedimentation rate (ESR) was raised in the two patients in whom it was measured. Serosal fibrosis is a rarely reported adverse eVect of pergolide treatment, although it is well described with other dopamine agonists. We suggest that patients with Parkinson's disease who receive pergolide treatment should be regularly monitored for the development of such complications. (J Neurol Neurosurg Psychiatry 1999;66:79-81)

Pergolide-Induced Dyspnea, Bilateral Pleural Effusion and Peripheral Edema

“…Symptoms emerged on average 2 years after the initiation of treatment and were characterized by a significant delay in diagnosis [7]. Edema and pleural effusion have rarely been described [6, 7, 8]. Specifically, pergolide-induced edema formation is rarely described [8].…”

“…Recently, three cases of pergolide-induced fibrosis of the pericardium, retroperitoneum and pleura were described. Symptoms emerged on average 2 years after the initiation of treatment and were characterized by a significant delay in diagnosis [7]. Edema and pleural effusion have rarely been described [6, 7, 8].…”

Drug-induced retroperitoneal fibrosis: short aetiopathogenetic note, from the past times of ergot-derivatives large use to currently applied bio-pharmacology

“…Their possible fibrogenic mechanisms are quite same as that of methysergide, by inducing the serotonin rebound release-mediated activation of myofibroblasts to overproduce ECM fibrogenic components, as well as the reactive fibrotic process might be thought, in addition, as an immune response to such drugs acting as haptens (22)(23)(24).…”

“…However a detailed study (28) shows that cabergoline, though administered for longterm treatment of hyperprolactinemia/acromegaly, wouldn't seem to be linked with an enhanced risk of fibrotic events. Bromocriptine is used not only in the management of Parkinson's disease, neuroleptic malignant syndrome and pituitary prolactinoma,but also at times in the treatment of type 2 diabetes, with possible RPF onset after its long-term administration (22)(23)(24).…”

“…The most RPF secondary to use of either ergot-or L-dopa-derivatives or even analgesics, are dated at the 60s-80s of last century, given that furtherly their long-term use has been supplanted or kept under careful measures to prevent the RPF onset (8,9,(11)(12)(13)(14)(15)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). In this regard, to avoid, during the management of Parkinson's disease, the reported ergot derivative-related fibrotic damages, many experimental studies are today in progress, among which the piece of research, in animal modelswith the resort to optical/chemogenetic switches -to reach proper cell therapy measures fit for increasing the release of dopamine from midbrain neurons (50).…”