Late onset warfarin-induced skin necrosis

Area of Science:

• Cardiology
• Dermatology
• Pharmacology

Background:

• Warfarin is a common anticoagulant medication.
• Warfarin-induced skin necrosis (WISN) is a rare but serious adverse effect.
• WISN typically manifests within 3-6 days of warfarin initiation.

Observation:

• A 52-year-old male patient developed skin lesions.
• The patient had been on warfarin therapy for four years.
• The lesions were associated with acquired deficiencies in protein C and protein S, alongside abnormal liver function.

Findings:

• This case represents a rare instance of late-onset WISN.
• The patient's presentation suggests a potential link between prolonged warfarin use, protein deficiencies, and liver dysfunction in the development of WISN.
• The underlying mechanisms for late-onset WISN require further investigation.

Implications:

• This case highlights the importance of considering rare adverse drug reactions even after long-term therapy.
• Clinicians should be vigilant for WISN in patients on warfarin, regardless of treatment duration.
• Further research is needed to understand the pathophysiology of late-onset WISN and identify at-risk patients.