Nicorandil-induced peristomal ulcers: is nicorandil also associated with gastrointestinal fistula formation?

摘要

Sir, Further to the recently published report by Claeys et ol. of two patients with perivulval and perianal ulceration induced by nicorandil, we present a series of four cases of nicorandil-induced peristomal ulceration in patients with a previous history of diverticular disease requiring gastrointestinal surgery. To our knowledge this is a previously unreported association.Patient 1 was an 83-year-old woman who presented with painful vulval and peristomal ulceration. She had a defunction-ing colostomy following the development of a colovaginal fistula in 2004; a barium enema performed prior to the surgery demonstrated diverticular disease. In 2005 she presented with vaginal discharge and was found to have several vesicovaginal fistulae; however, these were managed conservatively because of medical comorbidity. She had a history of ischaeraic heart disease and had been taking nicorandil since 2001. Examination revealed three vulval ulcers and a well-defined sloughy peristomal ulcer. There were no clinical features of pyoderma gangrenosum (Fig. 1). Nicorandil was discontinued and alternative antianginal therapy (isosorbide mononitrate) commenced. At 2 months, the ulcers had healed widiout any additional treatment.