ABSTRACT
A female patient in the sixth decade of life developed renal failure secondary to gastrointestinal bleeding, which was non-responsive to conventional therapy. She was treated with terlipressin iv; showing improvement but developing, over the next few days, ischemia and necrosis of the toes in the lower extremities, simulating necrotizing vasculitis, without response to regular management. An alternative therapy, oral sildenafil 50mg BID, was used, with a rapid reversal of the clinical picture. The vasodilator action of sildenafil is useful in cases of ischemia induced by some drugs. The objective this report is to warm about the utility of sildenafil in some potentially severe cases, like the one above.
Subject(s)
Ischemia/drug therapy , Lypressin/analogs & derivatives , Piperazines/therapeutic use , Sulfones/therapeutic use , Toes/blood supply , Vasoconstrictor Agents/adverse effects , Vasodilator Agents/therapeutic use , Diagnosis, Differential , Esophageal and Gastric Varices/complications , Female , Gastrointestinal Hemorrhage/complications , Gastrointestinal Hemorrhage/drug therapy , Humans , Ischemia/chemically induced , Kidney Failure, Chronic/etiology , Lypressin/adverse effects , Lypressin/therapeutic use , Middle Aged , Polyarteritis Nodosa/diagnosis , Purines/therapeutic use , Shock, Hemorrhagic/complications , Shock, Hemorrhagic/drug therapy , Sildenafil Citrate , Terlipressin , Vasoconstrictor Agents/therapeutic useABSTRACT
Una paciente de la sexta década de la vida desarrolló fallo renal secundario a hemorragia digestiva incoercible, con datos de choque hipovolémico, por lo que fue tratada con tarlipresina iv, con lo que hubo mejoría, pero presentó isquemia y necrosis de los dedos en extremidades inferiores, simulando vasculitis necrotizante sin respuesta al manejo terapéutico habitual, por lo que se empleó como alternativa sildenafil oral 50 mg 2 veces al día, con reversión rápida de su cuadro clínico. La acción vasodilatadora del sildenafil demostró ser una opción útil en el presente caso y el objetivo de esta comunicación es alertar de la respuesta satisfactoria al sildenafil en casos de isquemia inducida por medicamentos, semejantes a lo que se presenta en la práctica médica (AU)
A female patient in the sixth decade of life developed renal failure secondary to gastrointestinal bleeding, which was non-responsive to conventional therapy. She was treated with terlipressin iv; showing improvement but developing, over the next few days, ischemia and necrosis of the toes in the lower extremities, simulating necrotizing vasculitis, without response to regular management. An alternative therapy, oral sildenafil 50mg BID, was used, with a rapid reversal of the clinical picture. The vasodilator action of sildenafil is useful in cases of ischemia induced by some drugs. The objective this report is to warm about the utility of sildenafil in some potentially severe cases, like the one above (AU)
