An 84-year-old woman presented with LVH, with a history of liver cirrhosis due to hepatitis C virus (HCV) and alcoholism, portal hypertension, large esophageal varices in primary prevention with propylene glycol.
Endoscopic treatment with bands was performed and terlipressin 1.5 mg was started every four hours, administered in bolus.
At 24 hours she began with severe diffuse abdominal pain.
Spontaneous bacterial peritonitis and intestinal ischemia were ruled out by CT.
The next day, there was an appearance of bullous lesions in the hypogastrium and, in the following days, flank lesions and lesions in the periareo in both margins, with pericolic brown hematoma.
Skin biopsy revealed necrosis of the entire epidermis and focal detachment extending to the papillary dermis.
In the superficial dermis there was lymphocytic infiltrate and neutrophils with interstitial and perivascular distribution, without evidence of vasculitis or thrombus.
There was interstitial blood extravasation and immunofluorescence was negative.
In the clinical context, it was interpreted as cutaneous necrosis secondary to the administration of terlipressin, so it was discontinued.
On the following days, necrotic lesions evolved to dermis detachment, with granulation tissue appearing and complete improvement in a few weeks.
The patient was discharged 28 days after admission.
The patient and her daughter gave their consent for the publication of the case and the photographs.
