Collectively, ergots can occasion serosal thickening and effusions. Ergots can also cause valvular heart disease (VHD) requiring insertion of valve prosthesis (see under XIIb). Cases of retroperitoneal fibrosis have also been reported (The latter complication is not covered in Pneumotox. See at PMID 8588730 & 9886458). The anorexigens benfluorex, fenfluramine and dexfenfluramine can produce a similar pattern of VHD. The latter drugs have been recalled. A history of exposure to asbestos may increase both the incidence and the speed of progression of ergot-induced pleural pathology (PMID: 9493644)