title: Skin necrosis and protein C deficiency associated with vitamin K depletion in a patient with renal failure.
abstract: Skin necrosis similar to that induced by warfarin was seen in a patient who had never received the drug but who was vitamin K-deficient due to malnutrition and prolonged treatment with broad-spectrum antibiotics. He also had end-stage renal failure and was receiving prophylactic subcutaneous heparin therapy because of immobilization. His plasma protein C antigen level and, disproportionately, his plasma protein C functional activity were decreased. Both protein C values improved after vitamin K therapy, discontinuation of heparin, and initiation of hemodialysis. We surmise that skin necrosis occurred as a result of protein C deficiency caused by vitamin K depletion. Production of abnormal (descarboxy) protein C/protein S due to vitamin K deficiency and increased protein C inhibitory activity associated with renal failure and/or heparin administration may have contributed to the clinical picture. This rare but serious complication of a relatively common disorder, viz., vitamin K deficiency, reinforces the importance of vitamin K supplementation in malnourished patients who receive long-term antibiotic maintenance therapy.
authors.affiliation: Department of Medicine, Veterans Affairs Hospital, Hines, Illinois 60141.
authors.forename: R
authors.initials: R
authors.lastname: Soundararajan
authors.forename: D J
authors.initials: DJ
authors.lastname: Leehey
authors.forename: A W
authors.initials: AW
authors.lastname: Yu
authors.forename: T S
authors.initials: TS
authors.lastname: Ing
authors.forename: J B
authors.initials: JB
authors.lastname: Miller
mesh_terms: D000328:Adult; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D009336:Necrosis / Q000209:etiology; D020151:Protein C Deficiency; D006435:Renal Dialysis; D012867:Skin / Q000473:pathology*; D014813:Vitamin K Deficiency / Q000150:complications* / Q000209:etiology
chemical_list: D006493:Heparin