[Dermal necrosis as cutaneous manifestation of heparin-induced thrombocytopenia II?]

Most of the rare cases of skin necrosis following heparin injections are associated with the immunologically mediated form of heparin-induced thrombocytopenia II (HIT II). We present a 62-year- old woman who developed a necrotic abdominal lesion seven days after starting daily subcutaneous injections of the low molecular heparin enoxaparin. We detected circulating antibodies against the platelet factor 4-complex but no concomitant thrombocytopenia. An isolated, antibody-mediated thrombosis of dermal vessels is the likely underlying cause of the skin necrosis in HIT II.