title: Nonpalpable purpura within a setting of anticoagulant therapy and metastatic carcinoma.
abstract: The anticoagulant warfarin can produce a skin necrosis that is clinically indistinguishable from the skin necrosis caused by purpura fulminans associated with disseminated intravascular coagulation (DIC) and heparin-induced thrombocytopenia (HIT). The similar clinical and histologic findings observed in each of these skin necroses create a challenge for diagnosis and eventual treatment. The authors report a patient with significant risk factors for warfarin-induced skin necrosis, DIC, and HIT presenting with painful, purpuric patches beginning on her feet and extending proximally before becoming hemorrhagic bullae on her lower extremities.
authors.affiliation: Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Providence, RI, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Grenier
authors.forename: Catherine
authors.initials: C
authors.lastname: Chen-Tsai
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001706:Biopsy; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000556:secondary*; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000150:complications / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000473:pathology; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology; D008479:Mediastinal Neoplasms / Q000150:complications / Q000556:secondary*; D009336:Necrosis / Q000139:chemically induced / Q000473:pathology; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin