TERLIPRESSIN-INDUCED MUCOCUTANEOUS SKIN NECROSIS - REPORT OF 4 CASES

Vasopressin and its derivative terlipressin are vasoconstrictor hormon es used to treat haemorrhages caused by the rupture of esophagal varic es (resulting from portal hypertension). We report four cases of men w ith alcoholic cirrhosis who had ictero-edemato-ascitic decompensation with encephalopathy and haematemesis. All were treated by transfusion of red blood cells ranitidine terlipressin. Two of then were treated i n addition, with dopamine (at a vasodilating diuretic dose - 4 mu g/kg /min). Painless necrosis occurred at the terlipressin injection site b ut also at distance (tongue, scrotum...) less than 48 hours after the end of treatment. This necrosis was similar to that reported with vaso pressin, and may preceed or be concomittant with visceral necrosis. In these cases, terlipressin must be Immediately stopped because of the very high risk of mortality.