An unusual cutaneous reaction to anticoagulant therapy

Unusual complications of warfarin therapy include cutaneous necrosis and the "purple toe syndrome." The latter is more common in men and is not associated with vascular compromise; it usually occurs 3 to 8 weeks after warfarin therapy is begun and may persist for many months after the medication is discontinued. The following is a case of a 63-year-old woman who received warfarin therapy in conjunction with heparin for treatment of a left leg deep vein thrombosis. Approximately 8 hours after receiving her first dose of warfarin (15 mg), she developed acute pain, edema, and discoloration of the entire left leg to the mid-thigh, most prominent in the left great toe. After discontinuation of warfarin therapy, her symptoms completely resolved within 48 hours. This may be a report of a new cutaneous lesion associated with anticoagulant therapy.