Hepatorenal Sendromlu Bir Hastada Terlipressin Tedavisine İkincil Skrotal Nekroz

Hepatorenal sendrom, ilerlemiş karaciğer sirozu veya fulminan karaciğer yetmezliği olan hastalarda ortaya çıkan, tersinir bir akut böbrek yetmezliğidir. Terlipressin, hepatorenal sendromun tedavisinde kullanılan sentetik uzun süre etkili bir vazopressin analoğudur. Terlipressin ile tedavinin iskemik advers olayları bildirilmiştir. Karaciğer sirozu ve hepatorenal sendromlu bir hastada terlipressin kullanımının nadir görülen bir komplikasyonunu, skrotumun iskemik cilt nekrozunu sunuyoruz.

Anahtar Kelimeler:

Glipressin, Hepatorenal Sendrom, Karaciğer Sirozu, Vasküler

Secondary Scrotal Necrosis to Terlipressin Treatment in a Patient with Hepatorenal Syndrome

Hepatorenal syndrome is a reversible acute renal impairment that occurs in patients with advanced liver cirrhosis or fulminant hepatic failure. Terlipressin is a synthetic long-acting analogue of vasopressin that is used in the treatment of hepatorenal syndrome. Ischemic adverse events of the treatment with terlipressin have been reported. We present a rare complication of terlipressin usage, ischemic skin necrosis of the scrotum, in a patient with advanced liver cirrhosis and hepatorenal syndrome.

Keywords:

Glypressin, Hepatorenal Syndrome, Liver Cirrhosis, Vascular,

PDF

___

1. Gluud LL, Kjaer MS, Christensen E. Terlipressin for hepatorenal syndrome. Cochrane Database of Systematic Reviews 2006, Issue 4. Art No.: CD005162. DOI: 10.1002/14651858.CD00162.pub2. Available from: http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/ CD005162/pdf_fs.html
2. Moreau R, Durand F, Poynard T, et al. Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology. 2002;122:923–30.
3. Krag A, Borup T, Moller S, Bendtsen F. Efficacy and safety of terlipressin in cirrhotic patients with variceal bleeding or hepatorenal syndrome. Adv Ther. 2008; 25(11):1105-40.
4. Ortega R, Gines P, Uriz J, et al. Terlipressin therapy with and without albumin for patients with hepatorenal syndrome: results of a prospective, non-randomized study. Hepatology 2002;36(4):941–8.
5. Fabrizi F, Dixit V, Martin P. Meta-analysis: terlipressin therapy for the hepatorenal syndrome. Aliment Pharmacol Ther. 2006;24:935–44.
6. Ginés P, Torre A, Terra C, Guevara M. Review article: pharmacological treatment of hepatorenal syndrome. Aliment Pharmacol Ther. 2004;20(3):57–62.
7. Alessandria C, Ozdogan O, Guevara M, et al. MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation. Hepatology. 2005;41(6):1282-9.
8. Megarbane H, Barete S, Khosrotehrani K, et al. Two observations raising questions about risk factors of cutaneous necrosis induced by terlipressin (Glypressin). Dermatology. 2009;218(4):334-7.
9. Vaccaro F, Giorgi A, Riggio O, De Santis A, Laviano A, Rossi-Fanelli F. Is spontaneous bacterial peritonitis an inducer of vasopressin analogue side-effects? A case report. Dig Liver Dis. 2003;35:503-6.
10. Oh JE, Ha JS, Cho DH, Yu GJ, Shim SG. A case of ischemic skin necrosis after glypressin therapy in liver cirrhosis. Korean J Gastroenterol. 2008; 51(6) :381-4.