sildenafil-citrate and Gangrene

A man in his 70s, with a recent diagnosis of transitional cell carcinoma of the bladder, reported a 2-month history of discolouration, pain and paraesthesia affecting his fingers. Clinical assessment noted peripheral acrocyanosis with areas of digital ulceration and gangrene. Following further work-up to evaluate potential causes, he was diagnosed with paraneoplastic acrocyanosis. He proceeded to undergo robotic cystoprostatectomy and received adjuvant chemotherapy for the management of his cancer. In parallel to the chemotherapy, vasodilatory therapy was administered as two courses of intravenous synthetic prostacyclin analogue iloprost along with sildenafil. This resulted in a significant improvement in digital pain and gangrene with healing of ulceration.

Topics: Epoprostenol; Gangrene; Humans; Iloprost; Male; Sildenafil Citrate; Vasodilator Agents

Raynaud's phenomenon is a microvascular disorder that results in exaggerated vasoconstriction over vasodilatation secondary to an alteration in autonomic control. Though benign, it can result in severe ulceration and ultimately gangrene associated with disfiguration and permanent deformity. We present a case of severe secondary Raynaud's phenomenon in a black-African patient from a resource-limited setting, with focus on the difficulties encountered in the diagnosis and treatment.. A 43-year-old female Cameroonian farmer with a 7-year history of episodic paresthesia in her fingers and toes (when exposed to cold) presented to our emergency department with severe pain, ulceration, and "darkening" of her fingertips over a period of 2 days. An examination revealed bilateral ulceration and dry gangrene of her fingers and toes, based on which a diagnosis of secondary Raynaud's phenomenon due to a connective tissue disease was proposed. Results of paraclinical investigations were normal. Lifestyle modification along with a calcium channel blocker and phosphodiesterase type 5 inhibitor provided significant relief.. An early diagnosis and knowledge on appropriate treatment of Raynaud's phenomenon is of vital importance to prevent permanent tissue damage and disability. Relying on biphasic color change for the diagnosis of Raynaud's phenomenon in black Africans can be potentially misleading.

Topics: Adult; Analgesics, Opioid; Anti-Bacterial Agents; Black People; Calcium Channel Blockers; Cloxacillin; Connective Tissue Diseases; Directive Counseling; Female; Fingers; Gangrene; Humans; Life Style; Microcirculation; Nifedipine; Phosphodiesterase 5 Inhibitors; Raynaud Disease; Risk Reduction Behavior; Severity of Illness Index; Sildenafil Citrate; Toes; Tramadol; Treatment Outcome

Topics: Adolescent; Antiphospholipid Syndrome; Female; Foot Diseases; Gangrene; Humans; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Purpura; Sildenafil Citrate; Sulfones; Toes; Treatment Outcome