WARFARİNLE İLİŞKİLİ LÖKOSİTOKLASTİK VASKÜLİT VE CİLT NEKROZLU OLGU

Öz

Oral antikoagülanlar venöz ve arteryal embolileri önlemede ve tedavisinde yaygın olarak kullanılan ajanlardır. Doku nekrozu ve lökositoklastik vaskülit (LV) warfarine bağlı cilt reaksiyonlarındandır. Biz burada warfarin kullanırken ortaya çıkan LV olgusunu sunduk. Altmış bir yaşında erkek hasta, kronik obstruktif akciğer hastalığı (KOAH), kalp yetmezliği tanısı ile takip edilen ve 5 ay önce pulmoner emboli tanısı alan ve warfarin kullanan hasta son 2 haftadır artan nefes darlığı, öksürük, balgam çıkarma şikayetleri ile başvurdu. Fizik muayenesinde ayaklarında yer yer makülopapüler döküntüleri vardı. Hastanın takipte ayaklarında makülopapüler döküntüleri arttı ve ödemi gelişti, alt eksremitelerinde nekroze görünümler ve sırtında makülopapüler döküntüler ortaya çıktı. Warfarine bağlı cilt nekrozu ön planda düşünülen hastanın coumadini kesildi. Cleaxan tedavisine geçildi. Hastaya cilt biopsisi yapıldı. LV ile uyumlu olarak değerlendirildi. Kolşisin ve prednol 40 mg başlandı. Hastanın bilateral bacaklarındaki ve sırtındaki lezyonlarda belirgin gerileme izlendi. Sonuç olarak, warfarin kullanan hastalarda yeni gelişen cilt bulguları dikkatlice değerlendirilmeli ve warfarinin potansiyel yan etkileri göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Warfarin, lökositoklastik vaskülit

WARFARIN-INDUCED LEUKOCYTOCLASTIC VASCULITIS AND SCIN NECROSIS

Abstract

Oral anticoagulants are commonly used to prevent and treat venous and arterial embolism.Warfarin induced skin reactions include tissue necrosis and leukocytoclastic vasculitis (LV). Warfarin-induced LV case is presented here. 61 years old male patient. He has been followed-up for the diagnosis of chronic obstructive pulmonary disease (COPD), cardiac failure. He had been diagnosed as pulmonary embolism and started to use warfarin 5 months ago and admitted to hospital with the complaints of progressive dyspnea, cough, and phlegm in the last 2 weeks. According to the physical examination, he had sporadic maculopapular rash. Maculopapular rash increased in his feet during follow-up, and edema developed. After a while, necrosis signs in lower extremities and maculopapular rash in his back were occurred. Main diagnosis was considered as warfarin-induced skin necrosis, and coumadin was ceased. Low molecular weight heparine treatment was initiated. According to skin biopsy, it was compatible with LV. Colchicine, prednol 40 mg were initiated. Significant lesion improvement was observed on the bilateral legs and back of the patient. In conclusion, New skin signs should be evaluated carefully and potential side effects should be considered in the patients on warfarin.

Keywords

• Warfarin, leukocytoclastic vasculitis

Kaynakça

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