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Phenylephrine-induced microvascular occlusion syndrome in a patient with a heterozygous factor V Leiden mutation

Andrew H Kalajian1, Klark B Turpen, Kristin O Donovan

  • 1Division of Dermatology, Department of Medicine, University of Louisville, 310 E Broadway, Floor 2A, Louisville, KY 40202, USA. akalajian@yahoo.com

Archives of Dermatology
|October 17, 2007
PubMed
Abstract

Insights

Phenylephrine-induced vasoconstriction can trigger microvascular occlusion syndromes (MOS) in individuals with a thrombotic predisposition. Discontinuing the vasopressor led to complete resolution of MOS symptoms in a reported case.

Area of Science:

  • Dermatology
  • Vascular Medicine
  • Pharmacology

Background:

  • Cutaneous microvascular occlusion syndromes (MOS) manifest as noninflammatory retiform purpura.
  • Outcomes vary based on severity, duration, and cause, ranging from minor sequelae to severe conditions like peripheral gangrene.

Observation:

  • A middle-aged male patient presented with MOS following exposure to phenylephrine hydrochloride.
  • Symptoms resolved completely upon discontinuation of the vasopressor medication.
  • Subsequent genetic testing revealed a heterozygous factor V Leiden mutation, indicating a thrombotic predisposition.

Findings:

  • Phenylephrine-mediated vasoconstriction, combined with an underlying thrombotic tendency, likely precipitated the transient MOS.
  • This case highlights a potential, underreported cause of MOS in dermatologic literature.

Implications:

  • Vasopressor medications, particularly phenylephrine, should be considered as potential triggers for MOS.
  • Increased awareness among dermatologists regarding vasopressor-induced MOS is crucial for timely diagnosis and management.
  • Further research is warranted to explore the link between specific vasopressors and MOS development.

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