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

Abstract

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.

Terlipressin-induced ischaemic skin necrosis

“…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.…”

Practice guidance for the use of terlipressin for liver cirrhosis–related complications

“…Terlipressin can also cause skin and subcutaneous tissue ischemia with an incidence of <5%, [176][177][178][179] due to its vasoconstrictor effect on the systemic circulatory system. 180 Ischemia often occurs at the head, breast, abdominal wall, small intestine, scrotum as well as extremities.…”

Terlipressin‐induced foot ischemia

“…Peripheral ischemia is a rare and debilitating side effect of terlipressin 1‐3 . It is reported to develop after 48‐72 hours of initial dose 1 .…”

“…Peripheral ischemia is a rare and debilitating side effect of terlipressin 1‐3 . It is reported to develop after 48‐72 hours of initial dose 1 . Peripheral ischemia must be in the differentials if patients on terlipressin develop limb pains.…”

“…[1][2][3] It is reported to develop after 48-72 hours of initial dose. 1 Peripheral ischemia must be in the differentials if patients on terlipressin develop limb pains. All efforts should be placed to promptly identify the ischemia and prevent its progression to necrosis, which can be debilitating for the patient.…”