title: Warfarin-induced penile necrosis in a patient with heparin-induced thrombocytopenia.
abstract: A 56-yr-old man with lung adenocarcinoma presented with subsegmental pulmonary thrombosis. Platelet count on presentation was 531 x 10(9)/L. The patient was anticoagulated with subcutaneous low molecular weight heparin (LMWH). Next day, oral anticoagulation was initiated with 5 mg of warfarin once daily with LMWH and LMWH was discontinued at third hospital day. On the third day of oral anticoagulation therapy, he complained of left leg swelling and prolonged painful penile erection of 24 hr-duration. His platelet count reached a nadir 164 x 10(9)/L at that time, and the patient had a deficiency of protein C and S, with an activity level of 16% and 20% of normal value. Warfarin was stopped and he underwent penile aspiration. The next day, left leg edema and penile erection was disappeared, but penile and glans penis necrosis was started. This case illustrates that processes underlying heparin-induced thrombocytopenia (HIT) may also underlie warfarin-induced skin necrosis.
authors.affiliation: Department of Urology, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: In Ho
authors.initials: IH
authors.lastname: Chang
authors.forename: Moon Soo
authors.initials: MS
authors.lastname: Ha
authors.forename: Byung Hoon
authors.initials: BH
authors.lastname: Chi
authors.forename: Yong Wook
authors.initials: YW
authors.lastname: Kown
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis; D000925:Anticoagulants / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010410:Penile Erection / Q000187:drug effects; D010413:Penis / Q000473:pathology*; D010976:Platelet Count; D011486:Protein C / Q000032:analysis; D017293:Protein S / Q000032:analysis; D011651:Pulmonary Artery; D013921:Thrombocytopenia / Q000139:chemically induced*; D013927:Thrombosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D011486:Protein C; D017293:Protein S; D014859:Warfarin; D006493:Heparin
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