Ergotism: Case Report and Review of the Literature

Abstract

A case of ergotism is presented to illustrate the role of duplex ultrasonography in the diagnosis and management of this nonatherosclerotic cause of peripheral arterial disease. Historical aspects of ergotism are discussed together with reference to the relative vulnerability of different segments of the arterial circulation. Our case emphasizes the potential for complete reversibility of the vascular changes if recognized early.

Keywords

ergotism - ergot alkaloids - Claviceps purpurea - nonatherosclerotic arterial disease - lower limb ischemia - migraine - duplex ultrasound

• References

• 1 Tribble MA, Gregg CR, Margolis DM, Amirkhan R, Smith JW. Fatal ergotism induced by an HIV protease inhibitor. Headache 2002; 42 (7) 694-695
• 2 Enge I, Sivertssen E. Ergotism due to therapeutic doses of ergotamine tartrate. Am Heart J 1965; 70 (5) 665-670
• 3 Kelbessa U, Asfaw D, Yeshi W, Agata N, Abebe B, Wubalem Z. Laboratory studies on the outbreak of Gangrenous Ergotism associated with consumption of contaminated barley in Arsi, Ethiopia. Ethiop J Health Dev 2002; 16 (3) 317-323
• 4 Lee MR. The history of ergot of rye (Claviceps purpurea) I: from antiquity to 1900. J R Coll Physicians Edinb 2009; 39 (2) 179-184
• 5 Schiff PL. Ergot and its alkaloids. Am J Pharm Educ 2006; 70 (5) 98
• 6 Baldwin ZK, Ceraldi CC. Ergotism associated with HIV antiviral protease inhibitor therapy. J Vasc Surg 2003; 37 (3) 676-678
• 7 Garcia GD, Goff Jr JM, Hadro NC, O'donnell SD, Greatorex PS. Chronic ergot toxicity: A rare cause of lower extremity ischemia. J Vasc Surg 2000; 31 (6) 1245-1247
• 8 Merhoff GC, Porter JM. Ergot intoxication: historical review and description of unusual clinical manifestations. Ann Surg 1974; 180 (5) 773-779
• 9 Zavaleta EG, Fernandez BB, Grove MK, Kaye MD. St. Anthony's fire (ergotamine induced leg ischemia)—a case report and review of the literature. Angiology 2001; 52 (5) 349-356
• 10 Cagatay A, Guler O, Guven K. Ergotism caused by concurrent use of ritonavir and ergot alkaloids: a case report. Acta Chir Belg 2009; 109 (5) 639-640
• 11 Bagby RJ, Cooper RD. Angiography in ergotism. Report of two cases and review of the literature. Am J Roentgenol Radium Ther Nucl Med 1972; 116 (1) 179-186
• 12 Fagerberg S, Jorulf H, Sandberg CG. Ergotism, arteriospastic disease and recovery, studied angiographically. Acta Med Scand 1967; 182 (6) 769-772
• 13 Venter CP, Joubert PH, Buys AC. Severe peripheral ischaemia during concomitant use of beta blockers and ergot alkaloids. Br Med J (Clin Res Ed) 1984; 289 (6440) 288-289
• 14 Weaver R, Phillips M, Vacek JL. St. Anthony's fire: a medieval disease in modern times: case history. Angiology 1989; 40 (10) 929-932
• 15 Goldfisher JD. Acute myocardial infarction secondary to ergot therapy. N Engl J Med 1960; 262: 860-863
• 16 Mathey D, Montz R, Hanrath P, Kuck KH, Bleifeld W. Noninvasive method for recognition of coronary artery spasm: 201thallium sequential scintigraphy of themyocardium after ergotamine provocation (author's translation). (in English). Dtsch Med Wochenschr 1980; 105 (15) 509-515
• 17 Byrne-Quinn E. Arteriospasm after overdose of oral ergotamine tartrate in migraine. BMJ 1964; 2 (5408) 552-553
• 18 Ellison ABC. Ergot intoxication in a young woman with migraine (case report). W V Med J 1960; 56: 376-379
• 19 Lazarides MK, Karageorgiou C, Tsiara S, Grillia M, Dayantas JN. Severe facial ischaemia caused by ergotism. J Cardiovasc Surg (Torino) 1992; 33 (3) 383-385
• 20 Richter AM, Banker VP. Carotid ergotism. A complication of migraine therapy. Radiology 1973; 106 (2) 339-340
• 21 Fedotin MS, Hartman C. Ergotamine poisoning producing renal arterial spasm. N Engl J Med 1970; 283 (10) 518-520
• 22 Greene FL, Ariyan S, Stansel Jr HC. Mesenteric and peripheral vascular ischemia secondary to ergotism. Surgery 1977; 81 (2) 176-179
• 23 Hemingway DL. Ergot poisoning with multisystem involvement. Mil Med 1965; Nov 130 (11) 1103-1106
• 24 Demir S, Akin S, Tercan F, Ariboğan A, Oğuzkurt L. Ergotamine-induced lower extremity arterial vasospasm presenting as acute limb ischemia. Diagn Interv Radiol 2010; 16 (2) 165-167
• 25 Fischer GM, Llaurado JG. Collagen and elastin content in canine arteries selected from functionally different vascular beds. Circ Res 1966; 19 (2) 394-399
• 26 Hwang CW, Edelman ER. Arterial ultrastructure influences transport of locally delivered drugs. Circ Res 2002; 90 (7) 826-832