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Parkinson's disease patients receiving pergolide at risk
of serosal fibrosis

WESTPORT, Jan. 19 1999(Reuters Health) - Patients with
Parkinson's disease treated with ergot-derived dopamine
agonists should be monitored carefully for the development
of serosal fibrosis, Dr. S. Shaunak and colleagues of the
Norfolk and Norwich Hospital, Norwich, UK, report.

In the January issue of the Journal of Neurology, Neurosurgery
and Psychiatry, they describe the cases of three patients with
Parkinson's disease who developed pericardial, retroperitoneal
and pleural fibrosis associated with pergolide treatment.

In one case, a 63-year-old man with Parkinson's on 1 mg/day of
pergolide for two years developed left flank pain, weight loss
and mild anemia. He complained of right-sided chest pain and
nonproductive cough with an ESR of 40 mm/h, which rose to 55 mm/h. Chest
radiograph and CT showed bilateral pleural thickening.
Cardiac catheterization revealed constrictive pericarditis, Dr. Shaunak
and colleagues report.

In the second case, a 61-year-old man with Parkinson's received
up to 3 mg/day of pergolide for 2 years. He developed marked
edema  of the left leg with urinary frequency, nocturia and loin
pain. He had an ESR of 57 mm/h. Abdominal CT showed severe left
hydronephrosis and appearances consistent with retroperitoneal fibrosis,
the UK
team says.

In the third case, a 70-year-old male was placed on pergolide
for 18 months at a maximal dose of 3.75 mg/day. He developed
right shoulder pain and mild exertional dyspnea, according to
the researchers. ESR was not measured. Within 6 months, the
patient's pain became more severe and his dyspnea worsened.
Chest radiography and CT showed thickening of the pleura of
the right lung.

Dr. Shaunak and his colleagues recommend that Parkinson's
disease patients receiving ergot-derived dopamine agonists,
including drugs such as pergolide and cabergoline, undergo
annual chest radiographs and (ESR) measurement and that
clinicians remain vigilant for new systemic symptoms in
this patient population.

J Neurol Neurosurg Psychiatry 1999
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