Heparin-induced bullous hemorrhagic dermatosis

Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) have been used for years in the prophylaxis and treatment of thromboembolic disease. Cutaneous reactions to heparin include hematomas, ecchymoses, erythematous plaques, nodules, skin necrosis, contact dermatitis, and urticaria, all occurring more commonly at local subcutaneous injection sites. Generalized cutaneous reactions are more rare. We report the case of a man with no known risk factors who developed intraepidermal hemorrhagic bullae on distant sites after receiving intravenous UFH for suspected pulmonary embolism. He was diagnosed with heparin-induced bullous hemorrhagic dermatosis and recovered without further complications after discontinuation of the heparin. This case reveals that widespread cutaneous reactions to heparin may occur, though they are rare.