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Painful ANA-Positive Scleroderma-Like Disease With Acral Ulcerations: A Case of Chronic Gangrenous Ergotism

Department of Dermatology and Allergology, Academic Teaching Hosputal of the Technical University of Dresden, Dresden, Germany, wollina-uw{at}khdf.de

Gesine Hansel, MD

Institute of Pathology "Georg Schmorl", Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany

Monika Gruner, MD

Department of Dermatology and Allergology, Academic Teaching Hosputal of the Technical University of Dresden, Dresden, Germany

Jaqueline Schönlebe, MD

Institute of Pathology "Georg Schmorl", Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany

Birgit Heinig, Dipl-Med

Department of Physical Therapy, Hospital Dresden-Friedrichstadt, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany

Erich Köstler, MD

Department of Dermatology and Allergology, Academic Teaching Hosputal of the Technical University of Dresden, Dresden, Germany

Chronic ergotism is a rare cause of limb ischemia. In this case report, the authors present a 62-year-old woman with history of long-term use of ergotamine alkaloids for the treatment of menstrual pain, who developed a severe painful disease initially misdiagnosed as systemic sclerosis (scleroderma) for 3 decades. She presented with a combination of acral gangrene, foot ulcer, renal obstruction, mild pulmonary fibrosis, and reduced esophageal motility. Right-sided renal obstruction was evident. The condition was extremely painful and had led to muscular contractions and immobility, drug abuse, and anemia. After establishing the diagnosis of chronic gangrenous ergotism, changing drug therapy, mobilization, and treatment of chronic wounds, she showed a remarkable recovery. Eventually the foot ulcer was closed successfully using a mesh graft transplantation, and the patient was able to walk alone. Chronic ergotism is rare but has to be taken into account when presented with painful chronic digital and foot ulcers.

Key Words: chronic wounds • gangrene • fibrosis • ergotism • ergotamine alkaloids • dopamine antagonists • scleroderma

The International Journal of Lower Extremity Wounds, Vol. 6, No. 3, 148-152 (2007)
DOI: 10.1177/1534734607305308


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