Methysergide and retroperitoneal fibrosis.
Authors: R. J. Carr, B. K. Biswas
Journal: BMJ (1966)

Methysergide (Deseril) is at present the most potent drug for the prevention of migraine, and is being widely used, especially in America, as a long-term treatment.Withdrawal of the drug may be necessary in 200% of cases owing to side-reactions like persistent disequilibrium, vertigo, nausea, oedema, cramps, and aching pains in the groins and legs (Graham, 1964; Graham et al., 1966).Signs of vasoconstriction with cold feet and loss of peripheral pulses are not uncommon (Graham, 1964).Recently a very curious and serious condition has been described which occurred after long-term treatment with this drug.Graham (1964) reported two cases of retroperitoneal fibrosis from a series of 500 patients under prophylactic treat- ment for migraine with methysergide.Utz et al. (1965), from the Mayo Clinic, published a further three cases of retroperitoneal fibrosis which occurred after methysergide therapy.Graham et al. (1966), from Boston, described a series of 27 patients-10 of their own and 17 others-who developed the syndrome after treatment with methysergide.Though the association does not definitely prove that methy- sergide is the cause of retroperitoneal fibrosis, a similar case which has recently been investigated in the Bradford Royal Infirmary is considered worthy of publication.So far as we are aware, no similar case has been reported in the British literature. CASE REPORTA woman aged 33 was admitted to the medical wards on 23 January 1966 with a history of swelling of the feet and puffiness of the face for two weeks.She also complained of cramps in her legs and shortness of breath on exertion.Five years previously she was under investigation in another hos- pital for recurrent severe headache, and was diagnosed by a neuro- logist as suffering from migraine.No abnormality was detected in the heart, the x-ray film at that time showing a normal cardiac outline.The E.S.R. (Westergren) was 10 mm. in one hour.Since then she has been treated with Tofranil (imipramine hydrochloride), Cafergot, Novodil, and Stemetil (prochlorperazine) tablets for vary- ing periods.For the last six months she had been receiving methy- sergide tablets, 6 mg. a day, which had relieved her headaches completely.The tablets were discontinued only after admission to this hospital.On examination she was an anxious-looking woman.Oedema was present in the feet, hands, and face.B.P. was 150/80 mm.Hg.Heart sounds were normal.Pulsations were present in all peripheral arteries.There was tenderness in both renal angles, but the kidneys were not palpable.Investigations.-Her urine was sterile and the blood urea was 55 mg./100 ml.Serum protein and electrolytes were within normal limits.Haemoglobin was 11.8 g./100 ml. and W.B.C. 14,000/ c.mm. (polymorphs 10,640, lymphocytes 2,660, monocytes 560, .\osinophils 140).There was slight anisocytosis and the platelets were normal.The sensitized sheep-cell-agglutination test and latex- nucleoprotein test were negative.Serum antistreptolysin was 125 Todd units/ml.Serum calcium, inorganic phosphorus, and alkaline phosphatase were within normal limits, but the sedimentation rate was 124 mm. in one hour (Westergren).