Skin necrosis following prolonged administration of coumarin in a patient with inherited protein S deficiency.
Depression of the vitamin K-dependent modulators of coagulation during the initial phase of oral anticoagulant therapy may lead to a transient hypercoagulable state and skin necrosis. We report a case of skin necrosis associated with inherited protein S deficiency following prolonged coumarin therapy. As a result of a stasis ulceration causing a rise in c4b binding protein and concurrent treatment with topical sulfonamide, we hypothesize that a precipitous decrease in free protein S led to skin necrosis. Progression of the necrosis was halted with unactivated prothrombin complex concentrate. This case confirms the rare association between coumarin induced skin necrosis and protein S deficiency and emphasizes potential drug interactions.
Goldberg
S L
SL
Division of Hematology and Oncology, George Washington University Medical Center, Washington, DC 20037.
Orthner
C L
CL
Yalisove
B L
BL
Elgart
M L
ML
Kessler
C M
CM
D000328:Adult; D001798:Blood Proteins / Q000172:deficiency; D003374:Coumarins / Q000009:adverse effects*; D006023:Glycoproteins / Q000172:deficiency*; D006801:Humans; D008297:Male; D009336:Necrosis; D017293:Protein S; D012867:Skin / Q000187:drug effects* / Q000473:pathology; D013997:Time Factors
D001798:Blood Proteins; D003374:Coumarins; D006023:Glycoproteins; D017293:Protein S; C030123:coumarin