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Warfarin induced dermatitis and venous thrombosis in a patient with Protein S deficiency
R Quintavalla1, M Pini, C Manotti
1V Divisione Medica e Centro per le Malattie Emostatiche, Ospedale Regionale, Parma, Italy.
Abstract:
A case of warfarin-induced dermatitis in a 79 year-old patient with Protein S deficiency is described. Both total Protein S antigen and free Protein S were moderately reduced (about 50%). The skin lesion did not progress to frank necrosis and it was associated with elevated creatin phosphokinase (CPK) levels in plasma and with thrombosis of the anterior tibial vein localized to the area of dermatitis (probably warfarin-induced deep venous thrombosis). After warfarin withdrawal and beginning of heparin therapy, serum CPK rapidly normalized and the skin lesion improved.
Insights
Warfarin-induced dermatitis occurred in a patient with Protein S deficiency. Treatment involved stopping warfarin, initiating heparin, and resulted in improved skin lesions and normalized CPK levels.
Area of Science:
- Cardiology
- Dermatology
- Hematology
Background:
- Protein S deficiency is a risk factor for venous thromboembolism.
- Warfarin is a common anticoagulant used to prevent blood clots.
Observation:
- A 79-year-old patient with Protein S deficiency developed warfarin-induced dermatitis.
- The patient presented with skin lesions, elevated creatine phosphokinase (CPK) levels, and deep vein thrombosis.
Findings:
- Both total and free Protein S levels were reduced by approximately 50%.
- The skin lesions did not progress to necrosis.
- Warfarin withdrawal and heparin therapy led to rapid normalization of CPK and improvement of skin lesions.
Implications:
- This case highlights the potential complication of warfarin-induced skin necrosis in patients with Protein S deficiency.
- Early recognition and management, including switching to heparin, are crucial for favorable outcomes.
- Understanding the interplay between anticoagulation, protein S levels, and dermatological reactions is important for clinical practice.