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Case Reports
. 2020 Jan 15;13(1):e233089.
doi: 10.1136/bcr-2019-233089.

Terlipressin-induced ischaemic skin necrosis

Anand V Kulkarni  1 , Pramod Kumar  2 , Nagaraj P Rao  2 , Nageshwar Reddy  3
Affiliations
Case Reports

Terlipressin-induced ischaemic skin necrosis

Anand V Kulkarni et al. BMJ Case Rep. .

Abstract

Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.

Keywords: acute renal failure; alcoholic liver disease; dermatological; unwanted effects/adverse reactions.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Ischaemic necrosis on the lower limbs in case 1. (B) Cyanosis of the upper limb in case 2. (C) Cyanosis of the toes and necrotic purpuric lesions on the lower limbs in case 2.
Figure 2
Figure 2
Site of ischaemia reported in studies.
See this image and copyright information in PMC

References

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