II. History

  1. Seen in epidemic form since the Middle Ages
  2. Implicated in alleged behavior of Salem witches

III. Causes

  1. Excessive Ergot alkaloid drug intake
    1. Ergotamine
    2. Ergonovine
    3. Methylergometrine (Methergine)
    4. Methysergide (Sansert)
    5. Bromocriptine (Parlodel)
  2. Ergot alkaloid used concurrently with potentiator
    1. Azithromycin
  3. Rye or wheat infected with fungus Claviceps purpurea

V. Signs: Gangrene of poorly vascularized distal structures

  1. Tip of nose
  2. Ears
  3. Fingers
  4. Toes

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