Abstract
IntroductionAlthough nicorandil is prescribed widely, awareness of its potential to cause serious complications to the gastrointestinal tract mucosa is limited. Whilst nicorandil-induced oral and anal ulceration is well documented in the literature, nicorandil-induced fistulation is not. This is the first report in the literature of a single patient demonstrating simultaneous orocutaneous and anal fistulae during nicorandil therapy. Two separate cases of orocutaneous and anal fistulae associated nicorandil usage have previously been documented in specialist journals.Case presentationA 71-year-old Caucasian man presented with a 3-year history of concurrent orocutaneous and anal fistulae. He had been exposed to 30 mg twice-daily nicorandil therapy for 4 years. Both fistulae responded poorly to intensive and prolonged conventional treatment but healed promptly on reduction and eventual withdrawal of nicorandil therapy.ConclusionManagement of resistant cases of orocutaneous and anal fistulae in patients on high-dose nicorandil therapy may be impossible without reduction or even withdrawal of nicorandil.
Highlights
Nicorandil is prescribed widely, awareness of its potential to cause serious complications to the gastrointestinal tract mucosa is limited
Case presentation: A 71-year-old Caucasian man presented with a 3-year history of concurrent orocutaneous and anal fistulae
Management of resistant cases of orocutaneous and anal fistulae in patients on highdose nicorandil therapy may be impossible without reduction or even withdrawal of nicorandil
Summary
Nicorandil was first introduced as an anti-anginaltreatment in Japan over 20 years ago and is widely prescribed in the UK [1]. Journal of Medical Case Reports 2009, 3:119 http://www.jmedicalcasereports.com/content/3/1/119 case of orocutaneous fistula following nicorandil therapy and another letter [11] reporting a case of nicorandil-associated peri-anal fistula formation. Many of these case reports appear in specialised cardiology, dermatology, surgery and dentistry journals. Following reviews by clinicians in the areas of dermatology, microbiology, ENT (ear nose and throat) and maxillofacial surgery, the significance of this patient's nicorandil treatment (30 mg twice daily) initiated 4 years previously, was recognised His drug history included spironolactone, isosorbide mononitrate, warfarin, gliclazide, bisoprolol, paroxetine and furosemide. The fistula healed in mid2005, corresponding to a coincidental nicorandil dose reduction from a total daily dose of 60 mg to 30 mg during the preceding month
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