Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-10T12:46:32.570Z Has data issue: false hasContentIssue false
  • English
  • Français

An unusual case of warfarin-induced pinna skin necrosis

Published online by Cambridge University Press:  17 October 2008

M Martinez Del Pero ,
S Verma ,
A Espeso ,
M Griffiths  and
P Jani
M Martinez Del Pero*
Affiliation:
Department of ENT, Addenbrooke's Hospital, Cambridge, UK
S Verma
Affiliation:
Department of ENT, Addenbrooke's Hospital, Cambridge, UK
A Espeso
Affiliation:
Department of ENT, Addenbrooke's Hospital, Cambridge, UK
M Griffiths
Affiliation:
Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
P Jani
Affiliation:
Department of ENT, Addenbrooke's Hospital, Cambridge, UK
*
Address for correspondence: Mr M Martinez Del Pero, Clinical Research Fellow, Department of Otolaryngology, University of Cambridge Addenbrooke's NHS Trust, Hills Road, Cambridge CB1 1QQ, UK. Fax: 01223 217559 E-mail: marcos@doctors.org.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Warfarin-induced skin necrosis is a rare but recognised complication of this drug. The condition predominantly affects the breasts, buttocks and thighs of obese, peri-menopausal women. We present the case of a patient with the condition in an unusual site, and we discuss the management challenges involved.

Case report:

An 82-year-old man presented to the ENT department with a diagnosis of pinna haematoma. There was no history of trauma or infection. The patient was taking warfarin long-term for recurrent deep vein thrombosis. Two weeks prior to admission, the patient had had a loading course of warfarin following surgery. Multiple clinical teams were involved in treatment. The only abnormal laboratory investigation was a low protein S level; biopsy showed skin necrosis.

Conclusion:

In this case, the unusual presentation created diagnostic confusion, and may have precipitated aggressive surgical debridement. However, a more conservative management strategy was used, which we would recommend in future.

Keywords

Skin NecrosisPinna NecrosisWarfarin Therapy Complication
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 6 , June 2009 , pp. 685 - 688
Copyright
Copyright © JLO (1984) Limited 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Egred, M, Rodrigues, E. Purple digit syndrome and warfarin-induced skin necrosis. Eur J Intern Med 2005;16:294–5CrossRefGoogle ScholarPubMed
2 Roche-Nagle, G, Robb, W, Ireland, A, Bouchier-Hayes, D. Extensive skin necrosis associated with warfarin sodium therapy. Eur J Vasc Endovasc Surg 2003;25:481–2CrossRefGoogle ScholarPubMed
3 Warkentin, TE, Sikov, WM, Lillicrap, DP. Multicentric warfarin-induced skin necrosis complicating heparin-induced thrombocytopenia. Am J Hematol 1999;62:44–83.0.CO;2-F>CrossRefGoogle ScholarPubMed
4 Scandling, J, Walker, BK. Extensive tissue necrosis associated with warfarin sodium therapy. South Med J 1980;73:1470–2CrossRefGoogle ScholarPubMed
5 Amato, L, Berti, S, Fabbri, P. Warfarin-induced skin necrosis. Skin Med 2003;2:127–30CrossRefGoogle ScholarPubMed
6 Beitz, JM. Anticoagulant-induced skin necrosis. Am J Nurs 2004;104:31–2CrossRefGoogle ScholarPubMed
7 Clark, JA, Bremner, BR. Fatal warfarin-induced skin necrosis after total hip arthroplasty. J Arthroplasty 2002;17:1070–3CrossRefGoogle ScholarPubMed
8 Moll, S. Warfarin-induced skin necrosis. Br J Haematol 2004;126:628CrossRefGoogle ScholarPubMed
9 Ward, CT, Chavalitanonda, N. Atypical warfarin-induced skin necrosis. Pharmacotherapy 2006;26:1175–9CrossRefGoogle ScholarPubMed
10 Sanchez-Politta, S, Angelillo-Scherrer, A, Masouye, I, Borradori, L. Widespread skin necrosis associated with unfractionated heparin therapy in a patient under chronic coumarin anticoagulation. J Eur Acad Dermatol Venereol 2006;20:327–30CrossRefGoogle Scholar
11 Chan, YC, Valenti, D, Mansfield, AO, Stansby, G. Warfarin induced skin necrosis. Br J Surg 2000;87:266–72CrossRefGoogle ScholarPubMed
12 Tai, CY, Ierardi, R, Alexander, JB. A case of warfarin skin necrosis despite enoxaparin anticoagulation in a patient with protein S deficiency. Ann Vasc Surg 2004;18:237–42CrossRefGoogle Scholar
13 Khalid, K. Warfarin-induced necrosis of the breast: case report. J Postgrad Med 2004;50:268–9Google ScholarPubMed
14 Parsi, K, Younger, I, Gallo, J. Warfarin-induced skin necrosis associated with acquired protein C deficiency. Australas J Dermatol 2003;44:57–61CrossRefGoogle ScholarPubMed
15 Scarff, CE, Baker, C, Hill, P, Foley, P. Late-onset warfarin necrosis. Australas J Dermatol 2002;43:202–6CrossRefGoogle ScholarPubMed
16 Comp, PC, Elrod, JP, Karzenski, S. Warfarin-induced skin necrosis. Semin Thromb Hemost 1990;16:293–8CrossRefGoogle ScholarPubMed
17 Bauer, KA. Hypercoagulability – a new cofactor in the protein C anticoagulant pathway. N Engl J Med 1994;330:566–7CrossRefGoogle ScholarPubMed
18 Essex, DW, Wynn, SS, Jin, DK. Late-onset warfarin-induced skin necrosis: case report and review of the literature. Am J Hematol 1998;57:233–73.0.CO;2-B>CrossRefGoogle ScholarPubMed
19 Lewandowski, K, Zawilska, K. Protein C concentrate in the treatment of warfarin-induced skin necrosis in the protein C deficiency. Thromb Haemost 1994;71:395Google ScholarPubMed
20 DeFranzo, AJ, Marasco, P, Argenta, LC. Warfarin-induced necrosis of the skin. Ann Plast Surg 1995;34:203–8CrossRefGoogle ScholarPubMed