Lingual Ischemia as a Rare Complication of Terlipressin Therapy: A Case Report

Terlipressin is a synthetic analogue of vasopressin commonly used in the management of hepatorenal syndrome due to its potent and selective vasoconstrictive effects on the splanchnic circulation. Although generally well tolerated, it is associated with rare but potentially severe ischemic complications. This report describes a 76-year-old woman who was admitted with asthenia and progressive abdominal distension. Her medical history included hypertension, hypercholesterolemia, obesity, chronic atrial fibrillation, chronic heart failure, chronic kidney disease, and metabolic dysfunction-associated steatotic liver disease with large-volume ascites. On admission, she was hypotensive and disoriented, with laboratory findings consistent with hepatic and renal dysfunction. She was diagnosed with spontaneous bacterial peritonitis and treated with ceftriaxone. Due to hepatorenal syndrome and grade 4 hepatic encephalopathy, she was transferred to the ICU and received human albumin (1 g/kg/day for two days) and terlipressin (6 mg/day). On the fourth day of terlipressin administration, the patient developed rapidly progressive tongue ischemia, prompting immediate discontinuation of the drug. Despite supportive measures, her condition deteriorated, leading to refractory shock and death on the sixth day of hospitalization. Lingual necrosis is a very rare ischemic complication associated with terlipressin use. Prompt recognition is essential for immediate drug withdrawal and potential prevention of fatal outcomes.