Pergolide
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Retroperitoneal fibrosis and heart valvulopathy in an elderly patient: case report A 68-year-old man developed heart valvulopathy requiring heart surgery, and retroperitoneal fibrosis during treatment with pergolide. The man, who had been diagnosed with Parkinson’s disease 3 years earlier and was receiving pergolide 1mg twice daily, was admitted with acute pulmonary oedema, which had worsened over the last 6 months [duration of treatment to reaction onset not stated]. Eighteen months after pergolide initiation, he had developed renal function deterioration and oliguria. An abdominal CT revealed diffuse retroperitoneal fibrosis with bilateral compression of his kidneys and ureter. This led to hydronephrosis of this right kidney and a 7cm dense tissue mass in his retroperitoneal space. The man underwent placement of two endo-ureteral stents, which restored the patency of both ureters. His renal function temporarily improved, before deteriorating again with worsening fibrosis. Doppler analysis and echocardiography showed ascending aorta dilatation (diameter 5cm), moderate (2+/4+) aortic valve regurgitation with calcification and thickening of the aortic valve leaflets and mitral valve insufficiency (1+/4+) with similar changes. He had a left ventricle ejection fraction of 50%. Over the next 18 months, his aortic and mitral insufficiencies and ejection fraction gradually worsened. He received diuretics, which temporarily controlled his symptoms. However, over the next 6 months, his renal function deteriorated and he required three haemodialysis sessions a week. Following emergency admission for acute dyspnoea, a repeat echocardiogram showed severe (3+/4+) mitral and aortic valve insufficiency and his ejection fraction was 40%. He underwent elective heart surgery with aortic and mitral valve replacement. His native cusps had thickening and dense diffuse fibrosis with calcification. Histopathological analysis showed local hyelinosis, diffuse excessive fibrosis and dystrophic calcification. He had an uneventful postoperative course requiring only epinephrine [adrenaline] and dopamine. On postoperative day 16, he was discharged in a good condition. Pergolide was discontinued and he received hydrocortisone. His retroperitoneal fibrosis gradually improved and his renal function significantly improved. Forty-two months after heart surgery, he was in good health and did not require haemodialysis. Apostolakis EE, et al. Cardiac surgery in a patient with retroperitoneal fibrosis and heart valvulopathy, both due to pergolide medication for Parkinson’s disease. 803007318 Journal of Cardiothoracic Surgery 4: 65, 2009 - Greece
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Reactions 13 Mar 2010 No. 1292
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