title: Heparin-induced skin necrosis associated with thrombocytopenia and acquired protein C and protein S deficiency.
abstract: We have described a patient with colon cancer and liver metastases who developed heparin-induced thrombocytopenia and skin necrosis. We believe that the skin necrosis caused by the heparin/platelet factor 4 antibody was exacerbated by the acquired protein C and protein S deficiency. After the heparin was discontinued and infection treated, the skin necrosis and thrombocytopenia resolved. This case illustrates the fact that, in patients with heparin-induced skin necrosis, a search must be undertaken for an underlying pro-thrombotic state, which may precipitate the microthrombosis responsible for skin necrosis. We could not find any previous case reports of heparin-induced skin necrosis associated with isolated protein C deficiency, or combined protein C and protein S deficiency.
authors.affiliation: Division of Hematology/Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. hskprasad@gmail.com
authors.forename: H Keshava
authors.initials: HK
authors.lastname: Prasad
authors.forename: Rangaswamy
authors.initials: R
authors.lastname: Govindarajan
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D003110:Colonic Neoplasms / Q000601:surgery; D005260:Female; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D009336:Necrosis; D012867:Skin / Q000187:drug effects / Q000473:pathology*; D013921:Thrombocytopenia / Q000139:chemically induced*; D013927:Thrombosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin