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Colegio de Medicina Interna de México.

2020, Number 3

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Med Int Mex 2020; 36 (3)

Intoxication by ergotamine. Diagnostic and therapeutic implication

Macedo-Calvillo L, Escutia-Cuevas HH, Castro-Gutiérrez A, Fuentes-Malo E

Language: Spanish
References: 24
Page: 418-423
PDF size: 359.19 Kb.


ABSTRACT

Background: Ergotism refers to the toxic manifestations of ergot derivatives, the main cause of ergotism in industrialized countries is iatrogenic. Cardiovascular manifestations are secondary to cerebral and coronary vasospasm.
Clinical case: A 59-year-old man, who started 7 days before with headache and photophobia, self-administered ergotamine for 5 days, the sixth day presented phosphenes, diaphoresis, nausea, syncope and typical precordial angina with spontaneous remission; 24 hours later patient suffered neurological deterioration. It was documented bradycardia, hypotension and ST segment elevation of the inferior wall. Coronary angiography with no significant coronary stenosis; patient continued with refractory hypotension in spite of inotropes and liquid infusions, cerebral tomography with no abnormalities. In suspicion of ergotism, nitroglycerin treatment was started, and vasopressors and inotropes were removed with gradual improvement of the cardiovascular state and neurological conditions, with a single sequela of incomplete left homonymous hemianopsia.
Conclusion: The diagnosis of this rare disease can only be integrated with a meticulous clinical history as well as the clinical suspicion of ergotamine intoxication, being its treatment quite different to other differential diagnoses, the main importance of its characterization.


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