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Improvement of peripheral artery disease with Sildenafil and Bosentan combined therapy in a patient with limited cutaneous systemic sclerosis: A case report.
- Source :
-
Medicine [Medicine (Baltimore)] 2017 Jun; Vol. 96 (25), pp. e6988. - Publication Year :
- 2017
-
Abstract
- Rationale: Sildenafil, a phosphodiesterase-5-inhibitor and Bosentan, an endothelin-1-receptor antagonist combined therapy could have beneficial effect in systemic sclerosis (SSc) patients with peripheral artery disease.<br />Patient Concerns: We report a case of a 48-year-old Black woman, who developed severe left limb claudication and walking limitation following a left femoropopliteal bypass occlusion in 2014. She was a heavy smoker and had a history of right middle cerebral artery ischemic stroke and bilateral Raynaud phenomenon.<br />Diagnoses: According to the American College of Rheumatology/European League Against Rheumatism-2013 criteria, diagnosis of limited cutaneous SSc was retained with macrovascular lesions. She was referred for investigation of left limb claudication on treadmill using transcutaneous oxygen pressure measurement during exercise to argue for the vascular origin of the walking impairment. She had a severe left limb ischemia and the maximum walking distance (MWD) she reached was 118 m in March 2015 despite the medical optimal treatment and walking rehabilitation.<br />Interventions: Sildenafil, 20 mg tid, was introduced due to active digital ulcers. In July 2015, the MWD increased to 288 m, then to 452 m in December 2015. Adding Bosentan to Sildenafil to prevent recurrent digital ulcers resulted in an MWD of 1576 m.<br />Outcomes: Recently, the patient is treated with the combined therapy. She has no more pain during walking and his quality of life has improved.<br />Lessons: Sildenafil and Bosentan combined therapy was associated in our case with an improvement of MWD without adverse effect. Further clinical trials are necessary to confirm our original observation.
- Subjects :
- Bosentan
Drug Therapy, Combination
Endothelin Receptor Antagonists therapeutic use
Female
Humans
Middle Aged
Phosphodiesterase 5 Inhibitors therapeutic use
Scleroderma, Systemic drug therapy
Cardiovascular Agents therapeutic use
Peripheral Arterial Disease complications
Peripheral Arterial Disease drug therapy
Scleroderma, Systemic complications
Sildenafil Citrate therapeutic use
Sulfonamides therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1536-5964
- Volume :
- 96
- Issue :
- 25
- Database :
- MEDLINE
- Journal :
- Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 28640077
- Full Text :
- https://doi.org/10.1097/MD.0000000000006988