University of Medicine and Pharmacy Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Painful, slow-healing ulcers of the fingers are most common in patients with
progressive systemic sclerosis. Prostaglandine E1(PGE1) is a vasodilatator that has been found to reduce
the pain of the severe periphereal arterisclerotic vascular disease and to promote healing of the
accompanying ulcers.
Clinical case: We present the case of a 46-years old, female, allergic to Hymenoptera venom,
and witch in 2010 received swine flu vaccine. In october 2010, she reach on the departament of
Rheumatology, Targu Mures accusing pain and swelling in the extremities, skin changes at the same
level accompanied by vasomotor disturbances at cold. Having in mind this clinical appearance of skin,
typical for scleroderma, Associated with the mesenchymal nonspecific inflammatory syndrome proven
by laboratory test, with increased antibody titer (antinuclear antibodies-ANA: 45.2 UI/ml and
topoisomerase-I antibodies-anti Scl 70: 39.5 UI/ml) and after radiographic appearance of early
resorption of the distal phalanx, IV finger, right hand is given a diagnosis of progressive systemic
scleroderma and we have initiated a background treatment with methotrexate. But after two months the
disease progresses rapidly with necrotizing vasculitis and pulmonary injury. So we initiated a treatment
with cyclophosphamide 600 mg intravenously with favorable evolution until October 2011 when it
stopped due to a suspected hemorrhagic cystitis, and when peripheral ischemia occur we decide to
introduce back azathioprine in the treatment plan but with modest results resuming the treatment with
Cyclophosphamide in May 2012, which was Associated with Alprostadilum and in February 2013reenter Methotrexate. In january 2014,after the treatment with Alprostadilum, the patient suddenly
accuse chills, low grade fever, muscular pain, without auscultatory lung changes, arrhythmic heart
sounds, with ischemic changes on electrocardiogram, rising the suspicion of an acute coronary
syndrome, but which was rejected after cardiological examination. Subsequently, after two days, the
patient presents coffee grounds vomiting for which was made an upper gastrointestinal endoscopy in
emergency, which shows no active bleeding source. Concidering progressive hemodynamic alterations,
the patient is transferred in Gastroenterology Clinic where is established the diagnosis of acute gastric
ulcer with upper gastrointestinal bleeding. After 2 weeks, the patient presents in the emergency room in
bad general condition with necrotic changes in the fingers and she was hospitalized to the intensive care
unit with inflammatory syndrome, marked anemia, hepatic and renal failure, pleural effusion fluid with
cytopathology diagnosis of atypical cells and suspected neoplastic process having a rapidly evolution to
death.In conclusion even if we considered all aspects and risk factors related to the patient’s disease,
when we prescribe Alprostadilum we should expect to face a tragic outcome
