Persistent orocutaneous and anal fistulae induced by nicorandil: a case report

<p>Abstract</p> <p>Introduction</p> <p>Although nicorandil is prescribed widely, awareness of its potential to cause serious complications to the gastrointestinal tract mucosa is limited. Whilst nicorandil-induced oral and anal ulceration is well documented in the literature, nicorandil-induced fistulation is not. This is the first report in the literature of a single patient demonstrating simultaneous orocutaneous and anal fistulae during nicorandil therapy. Two separate cases of orocutaneous and anal fistulae associated nicorandil usage have previously been documented in specialist journals.</p> <p>Case presentation</p> <p>A 71-year-old Caucasian man presented with a 3-year history of concurrent orocutaneous and anal fistulae. He had been exposed to 30 mg twice-daily nicorandil therapy for 4 years. Both fistulae responded poorly to intensive and prolonged conventional treatment but healed promptly on reduction and eventual withdrawal of nicorandil therapy.</p> <p>Conclusion</p> <p>Management of resistant cases of orocutaneous and anal fistulae in patients on high-dose nicorandil therapy may be impossible without reduction or even withdrawal of nicorandil.</p

Nicorandil ulcer: moves beyond the mucosa

The management of wounds is a specialty in its infancy. Success requires more than the use of dressings. All wounds require a diagnosis, a point well illustrated by the management of these cases which depended solely on stopping nicorandil