Cortical hyperostosis secondary to prolonged use of prostaglandin E1.

Prostaglandin E1 (Alprostadil), a drug used for ductal patency in cyanotic congenital heart disease, comprises an essential part of the treatment of infants waiting for cardiac surgery in hospitals with no specialized medical staff or in situations of inadequate weight for surgery. Prostaglandin E1 (PgE1) can also be used in elevation of presurgical oxygenation status in more severe cases. The duration of infusion is often short (from 6 hours to 20 days). However, in some cases, when there is low birth weight, infection, or absence of a specialized hospital to transfer the patient to (all of these being common situation in developing countries), the infusion time can extend for weeks or months. Common side effects of prostaglandin therapy include apnea, fever, convulsions, rash, skin flushing, vasodilatation with hypotension, diarrhea, and gastric outlet obstruction. These effects are related to short-term use of PgE1, and the Pediatric Intensive Care Unit staff has the expertise to easily recognize and treat them. In rare situations of prolonged use of alprostadil, the most important side effects include soft tissue swelling and reversible cortical hyperostosis in the large bones. We describe the case of an infant presenting this complication secondary to prolonged use of PgE1, with typical and extensive radiological findings.