Warfarin-induced penile necrosis in a patient with heparin-induced thrombocytopenia.
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.
Chang
In Ho
IH
Department of Urology, College of Medicine, Chung-Ang University, Seoul, Korea.
Ha
Moon Soo
MS
Chi
Byung Hoon
BH
Kown
Yong Wook
YW
Lee
Sang-Jae
SJ
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*
D000925:Anticoagulants; D011486:Protein C; D017293:Protein S; D014859:Warfarin; D006493:Heparin
Ann Intern Med. 1984 Jul;101(1):59-60
6547283
J Eur Acad Dermatol Venereol. 1998 May;10(3):248-52
9643330
Ann Vasc Surg. 1991 Jul;5(4):370-4
1878296
Heart Vessels. 2007 Jan;22(1):64-6
17285450
Ann Intern Med. 1997 Nov 1;127(9):804-12
9382401
Arch Intern Med. 2004 Jan 12;164(1):66-70
14718324
Am J Hematol. 2004 Jun;76(2):176-9
15164386
J Assoc Physicians India. 2006 Dec;54:963-4
17338082
J Urol. 1989 Apr;141(4):946-8
2648033
Thromb Haemost. 1997 Aug;78(2):785-90
9268171
Br J Haematol. 2004 Sep;126(5):628
15327512
J Urol. 2003 May;169(5):1795
12686840
Am J Hematol. 1999 Sep;62(1):44-8
10467275
J Cardiothorac Vasc Anesth. 2000 Apr;14(2):188-90
10794341
Int J Lab Hematol. 2008 Aug;30(4):339-43
18665833
Chest. 2004 Sep;126(3 Suppl):311S-337S
15383477
J Urol. 2003 Oct;170(4 Pt 1):1318-24
14501756