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Case report
Terlipressin-induced ischaemic skin necrosis
  1. Anand V Kulkarni1,
  2. Pramod Kumar1,
  3. Nagaraj P Rao1 and
  4. Nageshwar Reddy2
  1. 1Hepatology and Liver Transplantation, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
  2. 2Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
  1. Correspondence to Dr Anand V Kulkarni; anandvk90{at}


Terlipressin is a commonly used drug in hepatology practice for the two most serious complications of cirrhosis, that is, acute oesophageal variceal bleed and hepatorenal syndrome. Acute-on-chronic liver failure (ACLF) is a medical emergency and is frequently associated with acute kidney injury (AKI). Two male patients with alcohol-induced ACLF with high MELD (Model for End-Stage Liver Disease) score presented with AKI. Both were treated with terlipressin infusion. There was no response to terlipressin in these sick patients, and further both patients developed ischaemic skin necrosis and succumbed to multiorgan failure. Continuous infusion of terlipressin is superior to bolus dosing, but we noted that continuous infusion might as well be associated with severe adverse effects in patients with a high MELD score. More extensive prospective studies, including patients with high MELD score, are required to ascertain the safety of terlipressin.

  • alcoholic liver disease
  • dermatological
  • unwanted effects/adverse reactions
  • acute renal failure
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  • Contributors AVK and PK made the study concept, collected the images and prepared the manuscript. Final input and technical support were provided by NPR and NR.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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