title: Delayed cutaneous hypersensitivity reactions to hirudin.
abstract: Hirudin is one of the new synthetic antithrombin agents, which is most commonly used in patients with type II heparin-induced thrombocytopenia and in patients with hypersensitivity reactions to unfractionated heparin as well as low-molecular-weight heparins. Hirudin is comparable to heparin as an antithrombotic agent and also has been studied as a primary treatment in patients who experienced acute myocardial infarctions. We describe a patient with a history of type II heparin-induced thrombocytopenia who was placed on intravenous hirudin therapy. After extravasation of the intravenous hirudin site, the patient developed a delayed hypersensitivity reaction that histologically showed an epithelioid granulomatous infiltrate. Although rare reports of hypersensitivity reactions to hirudin have been published, these reactions have not been well characterized and the histopathologic changes have not been described.
authors.affiliation: Department of Dermatology, University of Alabama, Birmingham, AL 35294-0009, USA. hskelton@pathuab.edu
authors.forename: K J
authors.initials: KJ
authors.lastname: Smith
authors.forename: J
authors.initials: J
authors.lastname: Rosario-Collazo
authors.forename: H
authors.initials: H
authors.lastname: Skelton
mesh_terms: D001706:Biopsy; D002114:Calcinosis / Q000473:pathology; D003094:Collagen; D003877:Dermatitis, Contact / Q000209:etiology* / Q000473:pathology; D004342:Drug Hypersensitivity / Q000209:etiology* / Q000473:pathology; D015622:Epithelioid Cells / Q000473:pathology; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006099:Granuloma / Q000473:pathology; D006493:Heparin / Q000009:adverse effects; D006629:Hirudins / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy; D012867:Skin / Q000187:drug effects / Q000473:pathology; D013921:Thrombocytopenia / Q000139:chemically induced
chemical_list: D005343:Fibrinolytic Agents; D006629:Hirudins; D006493:Heparin; D003094:Collagen