Recurrent coumadin-induced soft tissue necrosis resulting in mastectomy

A 58-year-old woman developed Coumadin-induced necrosis of the left breast, resulting in a mastectomy. This patient had experienced an earlier episode of coumadin-induced necrosis that resolved spontaneously. The etiology of this rare complication is unknown. The literature has suggested that patients can be restarted on Coumadin without difficulty. This case and others in the literature suggest that this may not be true. Patients requiring long-term anticoagulation should be considered for other treatment modalities if they develop Coumadin-induced skin necrosis.