Persistent Painful Indurated Erythema Secondary to Bosentan

Bosentan is an orally active antagonist of endothelin-1 (ET-1), an endogenous peptide considered one of the most potent and long-standing endogenous vasoconstrictors (1). Bosentan has been recently approved by the FDA for treatment of pulmonary arterial hypertension (PAH) (2, 3). This drug has been proven to show some clinical benefit for the ET-1 related disorders (1). Cutaneous side-effects secondary to bosentan have rarely been reported (4, 5). We herein describe a case developing an uncommon cutaneous reaction manifested by a genera-lized persistent painful indurated erythema secondary to bosentan treatment.CASE REPORTA 42-year-old woman with surgically corrected tetralogy of Fallot was admitted to the Department of Cardiology with suspicion of right ventricular failure secondary to PAH. Two months before the admission and 1 month after the onset of treatment with bosen-tan, (Tracleer