title: Multicentric warfarin-induced skin necrosis complicating heparin-induced thrombocytopenia.
abstract: Two patients developed catastrophic multicentric skin necrosis while receiving warfarin to treat venous thromboembolism complicated by immune-mediated heparin-induced thrombocytopenia (HIT). Patient 1 developed skin necrosis involving the breasts, thighs, and face, as well as venous limb gangrene and bilateral hemorrhagic necrosis of the adrenal glands, resulting in death. The second patient developed bilateral mammary necrosis necessitating mastectomies, as well as skin necrosis involving the thigh. Neither patient had an identifiable hypercoagulable syndrome, other than HIT. HIT may represent a risk factor for the development of multicentric warfarin-induced skin necrosis (WISN).
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada. twarken@fhs.mcmaster.ca
authors.forename: T E
authors.initials: TE
authors.lastname: Warkentin
authors.forename: W M
authors.initials: WM
authors.lastname: Sikov
authors.forename: D P
authors.initials: DP
authors.lastname: Lillicrap
mesh_terms: D000307:Adrenal Gland Diseases / Q000209:etiology; D000368:Aged; D000671:Amputation, Surgical; D000925:Anticoagulants / Q000009:adverse effects*; D016824:Antigens, Human Platelet / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000150:complications / Q000276:immunology; D016208:Databases, Factual; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced*; D004438:Ecchymosis / Q000139:chemically induced; D017809:Fatal Outcome; D005260:Female; D005734:Gangrene; D006470:Hemorrhage / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D009336:Necrosis; D011183:Postoperative Complications / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology; D012867:Skin / Q000098:blood supply / Q000473:pathology*; D012871:Skin Diseases / Q000139:chemically induced* / Q000601:surgery; D013848:Thigh; D013917:Thrombin / Q000378:metabolism; D013921:Thrombocytopenia / Q000139:chemically induced*; D019851:Thrombophilia / Q000139:chemically induced*; D013924:Thrombophlebitis / Q000188:drug therapy / Q000601:surgery; D016306:Vena Cava Filters; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D016824:Antigens, Human Platelet; D001323:Autoantibodies; D014859:Warfarin; D006493:Heparin; D013917:Thrombin