[Ergotism. A case report and review of the literature].

BACKGROUND

Ergotism is characterised by an intensive generalised vasoconstriction of small and large blood vessels. The symptoms derive from the regional ischemia caused by the vasospasm produced by ergotamine. Nowadays, ergotism is almost exclusively due to the excessive ingestion of ergotamine tartrate used in the treatment of migraine. The main treatment consists in withdrawing the medication.

METHODS

Our study involves a 53-year-old male with a history of migraine since his youth, who was treated with ergotaminic preparations up until the day before admission to hospital. He was admitted because of a 7-day history of symptoms including bilateral and symmetrical anaesthesia of the fingers and a general feeling of weakness, associated with intense pain and cyanosis of the right thenar eminence. On admission, it was not possible to measure his AT in the upper limbs and his peripheral pulses dropped in a generalised manner. Aetiologies involving vasculitis were ruled out. An angiography study showed segmented stenosis of arteries in the upper and lower limbs. Ergotaminic agents were withdrawn and nifedipine was indicated. The symptoms disappeared, the physical examination was normal and results of a control angiography study were also normal.

CONCLUSIONS

Ergotamine intoxication can be detected by a thorough interview and physical examination; it should be suspected when faced with symptoms that are compatible with vasospasms and a history of ingestion of the drug, in the absence of any prothrombotic, liver, kidney or vasculitic pathology. This condition is treated by withdrawing the drug and administration of vasodilators if the symptoms are intense. In this paper, we review the history, pathophysiology, initial symptoms and signs, diagnosis and treatment of ergotamine poisoning.