Objective: Report a case of extensive cutaneous necrosis due to apomorphine treatment with fatal outcome.

Background: Subcutaneous (SC) apomorphine is used as a treatment of motor fluctuations in Parkinson’s disease (PD). However, severe cutaneous complications may restrain its use.

Method: Case report.

Results: A 79 years old patient suffering from PD for the past 12 years with major motor fluctuations and dyskinesias, occurring in daytime as well as at night, was treated with SC apomorphine via pump. The treatment was efficient on the patient’s motor symptoms despite the emergence, after one year of treatment, of a number of minor and self-resolving cutaneous lesions in regard of the injection sites. Progressive skin deterioration of the limbs, trunk and abdomen appeared after 4 years of continuous SC infusions, requiring hospitalization. At the patient’s arrival in our unit, the doses of apomorphine administered were 9mg/h from 8am to 8pm and 5mg/h from 8pm to 8am, with a total dose of 168mg/d. Apomorphine was withdrawn and levodopa/benserazide therapy was progressively increased up to 2000mg/day, in addition to his usual treatment by pramipexole 2.1 mg (base). Deep cleaning of the wounds and mechanical debridement of the lesions were performed without improvement. The ulcerations gradually worsened, and his general status deteriorated, with a considerable increase of the amount of time spent in an “off” state. Lacking alternative treatment, palliative care and support were initiated with fatal outcome within 1 month.

Conclusion: Nodules and indurations induced by SC apomorphine infusions are frequently described side effects whose pathophysiology still remains to be clearly elucidated . The occurrence of skin necrosis, a more serious but fortunately less common complication, should raise the question of pursuing or not the treatment. To our knowledge, this is the first case of progressive deterioration of a patient’s skin condition, with a particularly severe evolution which lead to fatal outcome.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/fatal-evolution-of-cutaneous-necrosis-in-a-patient-treated-with-subcutaneous-apomorphine-infusions/