[Recurrent pyoderma gangrenosum-like ulcers induced by oral anticoagulants].
BACKGROUND
Other than the classic skin necrosis induced by oral anticoagulants (OAC) in patients with protein C and S deficiencies, other types of OAC induced-skin ulcers are little known. Herein, we describe an original case of recurrent pyoderma gangrenosum (PG)-like ulcers induced by OAC.


METHODS
A 70-year-old female heart-transplant recipient presented deep, hyperalgesic and quickly-spreading necrotic ulceration of the right leg 6 weeks after starting oral anticoagulant therapy with fluindione. Histological analysis revealed dermal infiltrate containing polynuclear neutrophils, which accords with the histopathological diagnosis of leukocytoclastic vasculitis or PG. Infectious, autoimmune and thrombophilic causes were ruled out. Fluindione was withdrawn and the ulcer healed completely within a month. Six months later, right leg ulceration recurred two weeks after the patient resumed fluindione but healed within 1 month of discontinuation of the drug. An OAC from another chemical family (warfarin) was then introduced, with further recurrence of ulceration after 2 weeks of treatment.


CONCLUSIONS
The chronology of events and the negativity of aetiological explorations allowed a diagnosis to be made of OAC-induced skin ulcer, a rare complication of which the pathophysiology is unclear. This is the first case of PG-like ulcers induced by OAC.
Service d'immunologie clinique et allergologie, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France. Electronic address: paulinepralong@yahoo.fr.
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P
Pralong
Service de dermatologie, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
S
S
Debarbieux
Centre régional de pharmacovigilance, 162, avenue Lacassagne, 69003 Lyon, France.
N
N
Paret
Service d'anatomopathologie, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
B
B
Balme
Service d'anatomopathologie, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
L
L
Depaepe
Service d'immunologie clinique et allergologie, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
A
A
Nosbaum
Service d'immunologie clinique et allergologie, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
B
B
Ben-Said
Service d'immunologie clinique et allergologie, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
J-F
JF
Nicolas
Service d'immunologie clinique et allergologie, centre hospitalier Lyon Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
F
F
Bérard
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000737:chemistry / Q000627:therapeutic use; D001510:Bed Rest / Q000009:adverse effects; D002280:Basal Cell Carcinoma / Q000601:surgery; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000175:diagnosis* / Q000209:etiology; D057915:Drug Substitution; D005153:Facial Neoplasms / Q000601:surgery; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology; D015394:Molecular Structure; D008998:Monoclonal Gammopathy of Undetermined Significance / Q000150:complications; D010630:Phenindione / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000737:chemistry / Q000627:therapeutic use; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis*; D017511:Pyoderma Gangrenosum / Q000175:diagnosis*; D012008:Recurrence; D012878:Skin Neoplasms / Q000601:surgery; D012883:Skin Ulcer / Q000139:chemically induced*; D013924:Thrombophlebitis / Q000188:drug therapy; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000175:diagnosis; D014859:Warfarin / Q000009:adverse effects* / Q000737:chemistry / Q000627:therapeutic use
D000925:Anticoagulants; D010630:Phenindione; D014859:Warfarin; C017673:fluindione
Antivitamines K; Induced skin ulcer; Leukocytoclastic angiitis; Oral anticoagulant; Pyoderma gangrenosum; Ulcère induit; Vasculite leucocytoclasique