Cortical hyperostosis, rare adverse effect of prostaglandin

Area of Science:

• Pediatric Cardiology
• Neonatal Pharmacology
• Skeletal Dysplasias

Background:

• Complex cyanotic heart disease necessitates interventions like prostaglandin infusion for ductal patency.
• Prostaglandin E1 is crucial for maintaining systemic circulation in ductal-dependent congenital heart defects.
• Long-term prostaglandin use can present with potential adverse effects.

Purpose of the Study:

• To report an uncommon side effect of long-term prostaglandin infusion in an infant with complex cyanotic heart disease.
• To document the clinical presentation, diagnosis, and management of prostaglandin-induced cortical hyperostosis.
• To highlight the importance of monitoring biochemical and radiological markers during prolonged prostaglandin therapy.

Main Methods:

• Case report of an infant girl with ductal-dependent complex cyanotic heart disease.
• Monitoring of alkaline phosphatase activity and clinical examination for signs of hyperostosis.
• Radiographic evaluation of long bones to assess for periosteal reaction.
• Successful surgical intervention with a Blalock-Taussig shunt.

Main Results:

• The infant received prostaglandin infusion for five months.
• Elevated alkaline phosphatase activity was observed after seven weeks of prostaglandin infusion.
• Clinical and radiographic findings confirmed cortical hyperostosis, an uncommon prostaglandin side effect.
• Symptoms resolved after discontinuing prostaglandin infusion.

Conclusions:

• Long-term prostaglandin infusion can lead to cortical hyperostosis and elevated alkaline phosphatase in infants.
• Early recognition and discontinuation of prostaglandin are crucial for managing this adverse effect.
• While the shunt procedure was successful, the infant unfortunately succumbed to infection post-operatively.