PS-057 Dry gangrene treated with SILDENAFIL and medication error

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BackgroundGangrene is defined as ischaemic damage. Fever followed by marked coldness, cyanosis, pain and restricted mobility of extremities should always raise suspicion of gangrene. Intravenous nitroprusside, prostaglandins and hyperbaric oxygen have been tried with little success. Despite therapeutic interventions, mortality of up to 40% and an amputation rate of 30–50% have been reported.PurposeThere are a few published reports on the use of sildenafil in dry gangrene. We describe the use of sildenafil in a patient with progressive systemic sclerosis.Material and methodsA clinical case and literature review.ResultsThe case was an 89-year-old institutionalised woman with arterial hypertension and a history of stroke. She was on acenocumarol and enalapril therapy. In February 2014, the patient showed necrosis of the third and fourth fingers of the left hand which were amputated, and the fifth finger of the right hand. The blood culture was negative. In November 2015, the patient attended the hospital emergency department with cyanosis, coldness and pain in the third finger of the right hand, which was amputated. 3 days after discharge, she showed cyanosis and pain in her fifth finger of the left hand, and necrotic tissue with bleeding blisters on the heels. During her hospital stay, sildenafil treatment was started and the condition of the patient improved, although without complete response. On 24 February 2016, the patient had problems buying sildenafil so her dermatologist changed to tadalafil. On 9 March 2016, she showed worsening of lesions. Acenocumarol was changed to apixaban due to the lesions worsening when acenocumarol doses were higher (we found several reports on gangrene due to the use of acenocumarol) although antiheparin antibody results were negative. On 26 March 2016, she was admitted to the vascular surgery service with pain and necrosis of the fifth finger of the left hand. Her doctor prescribed sildenafil and tadalafil because the nursing home´s prescription contained tadalafil but the dermatologist´s prescription contained sildenafil. This error did not affect the patient because when the pharmacist transcribed the prescription, she called the dermatologist who stopped both drugs during her hospital stay. The patient kept her fifth finger and continues with apixaban and sildenafil with remission of lesions.ConclusionThe use of sildenafil in patients with gangrene is occasional, and efficacy results come from isolated cases or series of cases. Sildenafil improves tissue perfusion and decreases erythema in affected areas.No conflict of interest

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