A Rare Case of Brachial Artery Obstruction: Possible Link with Pergolide

We present a case of a 51-year-old man, with an unusual occlusion of his brachial, radial and ulnar artery. Salvage of the extremity was achieved with a saphenous vein bypass from the axillary artery to the brachial artery at the elbow and subsequently a jump graft from the distal part of this bypass to the radial artery: histological analysis of the ulnar artery showed constriction of the vascular lumen by media-hyperplasia reminiscent of the medial fibroplasias-subtype of fibromuscular dysplasia. The brachial artery showed intimafibrosis and myxoid changes. These observations suggest a drug-induced or toxic cause, most likely to have been caused by pergolide. The precise mechanisms by which pergolide mediates its adverse vascular effects are unknown but may be related to ergotism. This type of side effect of pergolide has not been described before.