Cutaneous Ischaemia Following Terlipressin Therapy for Hepatorenal Syndrome

Hepatorenal Syndrome (HRS) is a potentially fatal complication of hepatic failure and portal hypertension. Among the various treatments available including octreotide, midodrine and albumin, the current standard of care for stable patients is terlipressin along with albumin. Although, terlipressin is considered safer than its parent molecule vasopressin, there have been reports of ischaemic side effects related to vasoconstrictor effects such as myocardial and mesenteric ischaemia. Cutaneous ischaemia has been reported in as few as 20 cases to date. We report the case of a gentleman who developed ischaemic skin lesions due to peripheral vasoconstriction following terlipressin thereapy for HRS and rapid reversal on discontinuing the drug. This and other similar cases highlight the need for larger studies exploring ischaemic side effects of terlipressin as well as close monitoring of patients for early detection of this side effect.