tailieunhanh - Báo cáo y học: "Effect of the dual endothelin receptor antagonist bosentan on untreatable skin ulcers in a patient with diabetes: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Effect of the dual endothelin receptor antagonist bosentan on untreatable skin ulcers in a patient with diabetes: a case report. | Alvarez Reyes et al. Journal of Medical Case Reports 2011 5 151 http content 5 1 151 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Effect of the dual endothelin receptor antagonist bosentan on untreatable skin ulcers in a patient with diabetes a case report Fatima Alvarez Reyes Cristina Luna Gomez and Manuel Brito Suárez Abstract Introduction Refractory skin ulcers are a major burden in patients with diabetes. Their pathogenesis is multifactorial and data increasingly implicate endothelin as a mediator of diabetic macro- and microvasculopathy. Here we describe the first reported case of an endothelin receptor antagonist being used to successfully treat refractory skin ulcers in a patient with diabetes. Case presentation An 85-year-old Caucasian man with a 30-year history of type 2 diabetes developed multiple skin ulcerations including a right heel ulcer. Despite appropriate treatment the ulcer showed little improvement and the risk of amputation was high. The patient was treated with the dual endothelin receptor antagonist bosentan. After three weeks of treatment major improvements were observed and after 21 weeks all ulcers had healed. No abnormalities were observed during monitoring of blood pressure erythrocyte sedimentation rate or serum aminotransferase levels. Conclusion In patients with refractory ulceration associated with diabetes bosentan may be of real benefit especially in terms of amputation prevention. This case supports the proposed role for endothelin in the pathogenesis of skin ulceration in diabetes and is suggestive of a potential benefit of bosentan in this patient type. This case report is of interest to diabetologists and dermatologists. Introduction Non-healing skin ulcers particularly those affecting the heel are major complications in diabetes and often lead to amputation below the knee 1 2 . The pathogenesis of these ulcerations is often multifactorial and includes Macrovasculopathy arterial .