A necrotic skin lesion in a dialysis patient after the initiation of warfarin therapy: a difficult diagnosis.
Necrotic skin lesions are unfortunately common in patients with end stage renal disease undergoing dialysis therapy. We present a case of a necrotic skin lesion in a peritoneal dialysis patient shortly after the initiation of warfarin therapy for atrial fibrillation. We discuss and contrast distinguishing features of two diagnostic possibilities: warfarin skin necrosis (WSN) and calcific uremic arteriopathy (CUA) in terms of clinical presentation, risk factors and pathology. Lastly, we outline the importance of establishing a diagnosis as treatment regimens differ substantially.
Rockx
Marie Antoinette
MA
Department of Medicine, Section of Nephrology, St. Boniface Hospital, University of Manitoba, Rm #BG007, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada.
Sood
Manish M
MM
D000925:Anticoagulants / Q000009:adverse effects*; D002115:Calciphylaxis / Q000175:diagnosis; D003928:Diabetic Nephropathies / Q000150:complications*; D003937:Diagnosis, Differential; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012871:Skin Diseases / Q000139:chemically induced* / Q000473:pathology; D014859:Warfarin / Q000009:adverse effects*
D000925:Anticoagulants; D014859:Warfarin