Late Onset of Warfarin-Induced Skin Necrosis: A Case Report with Review of the Literature

Year 2014, Volume: 21 Issue: 3, 223 - 225, 01.06.2014

Talat Kılıç Ömer Kaya Gazi Gülbaş Mehmet Ali Erkut Hüseyin Arpag

Abstract

Skin necrosis is a rare but serious complication of warfarin. A 68-year-old male patient was admitted with sudden chest pain,breathlessness and swelling of the left leg.The chest CT angiography showed thrombus both in the lower lobe pulmonary artery and its branches. Heparin and warfarin was administered. After a time,warfarin application was continued. Palpable petechiae and purpura developed the left leg and the knee in the 5th month of the treatment. Meanwhile,it was learned the patient had taken ibuprofen for 2 days before the development of the skin lesions. The examination showed that the patient had necrotic bullae on a dark erythhematous surface around the front of the right leg tibia. Skin necrosis was thought to be due to warfarin, and warfarin was stopped. Enoxaparin was initiated. Because the skin lesions did not improve,rivaroxaban treatment was started,and lesions eventually disappeared. Skin lesions should be evaluated with care in patients taking warfarin. Key words: Skin Necrosis; Warfarin; Rivaroxaban; Enoxaparin.

Keywords

Skin Necrosis; Warfarin; Rivaroxaban; Enoxaparin.

Geç Dönemde Warfarine Bağlı Gelişen Cilt Nekrozu: Literatür Eşliğinde Bir Olgu Sunumu

Abstract

Warfarine bağlı cilt nekrozu nadir, fakat önemli bir komplikasyondur. Altmışsekiz yaşında erkek hasta ani başlayan göğüs ağrısı, nefes darlığı ve sol bacakta şişlik ile başvurdu. Çekilen toraks bilgisayarlı tomografi anjiografide, her iki alt lob pulmoner arter ve dalları içerisinde trombüs izlendi. Hastaya heparin ve warfarin başlandı. Tedavinin 5. ayında sol bacakta diz etrafında yaygın palpabl peteşi ve purpura gelişti. Sağ bacak tibia ön yüzünde koyu eritemli zemin üzerinde nekrotik kurut ve bül izlenen plak görüldü. Bu arada, cilt lezyonları başlamadan önce iki gün süre ile ibuprofen aldığı öğrenildi. Hastanın cilt nekrozunun warfarine bağlı geliştiği düşünüldü ve warfarin kesilerek enoksaparin başlandı. Cilt lezyonları düzelmediğinden, rivaroksaban tedavisi başlandı. Rivaroksaban'dan sonra, cilt lezyonları kayboldu. Warfarin alan hastalarda, yeni gelişebilecek cilt lezyonları açısından kontrollerde hastaların mutlaka iyi sorgulanması gerektiğini vurgulamak amaçlı olgu sunulmuştur. Anahtar kelimeler: Cilt Nekrozu; Warfarin; Rivaroxaban; Enoxaparin

Keywords

Cilt Nekrozu; Warfarin; Rivaroxaban; Enoxaparin

References

• Nazarian RM, Van Cott EM, Zembowicz A, Duncan LM. Warfarin-induced skin necrosis: case & rewiev J Am Acad Dermatol 2009;61:325-32.
• Essex DW, Wynn SS, Jin DK. Late-onset warfarin-induced skin necrosis: case report and review of the literature. Am J Hematol 1998:57:233-7.
• Sternberg ML, Pettyjohn FS. Warfarin sodium-induced skin necrosis. Ann Emerg Med 1995;26:94-7.
• McLean J. The thromboplastic action of cephalin. Am J Physiol 1916;41:250-7.
• Flood EP, Redish MH, Bociek SJ, Shapiro S. Thrombophlebitis migrans disseminata: report of a case in which gangrene of a breast occurred. NY S J Med 1943;43:1121-4.
• De Franzo AJ, Marasco P, Argenta LC. Warfarin-induced necrosis of the skin. Ann Plast Surg 1995;34:203-8.
• Teepe R, Broekmans A, Vermeer B, Nienhuis A, Loeliger E. Recurrent coumarin-induced skin necrosis in a patient with an acquired functional protein C deficiency. Arch Dermatol 1986;122:1408-12.
• Cameron A, van Berkel W, Sixma J. Skin necrosis after three years of treatment with acenocoumarin. Ned Tijdschr Geneeskd 1974;118:505-7.
• Diana FJ, Veronich K, Kapoor AL. Binding of nonsteroidal anti-inflammatory agents and their effect on binding of racemic warfarin and its enantiomers to human serum albumin. J Pharm Sci 1989;78:195-9.