Warfarin skin necrosis associated with protein S deficiency and a mutation in the methylenetetrahydrofolate reductase gene.
The use of warfarin is rarely complicated by skin necrosis. We describe a 50-year-old woman who presented with a left leg deep venous thrombosis and subsequent pulmonary embolism. She was initially anticoagulated with low-molecular weight heparin and subsequently warfarin. Within 4 days abdominal skin necrosis developed. Investigations revealed the presence of protein S deficiency and in addition, a mutation in the methylenetetrahydrofolate reductase gene (MTHFR). We present, to our best knowledge, the first case of warfarin skin necrosis associated with a methylenetetrahydrofolate reductase mutation.
Byrne
J S
JS
Department of Dermatology, Beaumont Hospital & Private Clinic, Beaumont, Dublin 9, Ireland.
Abdul Razak
A R
AR
Patchett
S
S
Murphy
G M
GM
D000925:Anticoagulants / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology*; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics*; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D009336:Necrosis; D018455:Protein S Deficiency / Q000150:complications*; D020246:Venous Thrombosis / Q000188:drug therapy; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D014859:Warfarin; D042965:Methylenetetrahydrofolate Reductase (NADPH2)