2019, Number 1
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An Med Asoc Med Hosp ABC 2019; 64 (1)
Intoxication with ergotamine. Diagnostic and therapeutic implications. A case
Macedo CL, Castro GA, Escutia CHH, Ordoñez SBA
Language: Spanish
References: 24
Page: 58-63
PDF size: 326.51 Kb.
ABSTRACT
Ergotism refers to the toxic manifestations of ergot derivatives. In developed countries, the main cause of ergotism is iatrogenic. Cardiovascular manifestations are secondary to cerebral and coronary vasospasm.
Clinical case: 59-year-old man who started seven days before with headache and photophobia; he self-administered ergotamine for five days. The sixth day, he started with phosphenes, diaphoresis, nausea, syncope and precordial pain, with spontaneous remission; 24 hours later, he suffered neurological deterioration. We documented bradycardia, hypotension and ST segment elevation of the inferior wall. A coronary angiography was performed, without significant coronary stenosis; he continued with refractory hypotension in spite of inotropes and liquid resuscitation; the cerebral tomography appeared without alterations. In suspicion of ergotism, a nitroglycerin treatment was started and vasopressors and inotropes were removed, with gradual improvement of his cardiovascular state and neurological conditions, with a single sequelae of incomplete left homonymous hemianopsia. The diagnosis of this rare pathology can only be integrated with a meticulous clinical history as well as the clinical suspicion of ergotamine intoxication. Its treatment is quite different from that of other differential diagnoses, thus the main importance of its characterization.
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