title: [Necrotic leg ulcer revealing vasculitis induced by vitamin K antagonists].
abstract: Vitamin K antagonists are widely used in thromboembolic diseases. Hemorrhagic complications related to drug overdose represent their main side effect. We report a rare side effect, a severe and unexpected type of skin vasculitis - necrotic leg ulcer - induced by vitamin K antagonist.
  
  
  METHODS
  A 63-year-old female with a history of diabetes developed hyperalgesic necrotic ulcerations on the lower limbs one month after starting an acenocoumarol-based treatment for ischemic heart disease. Histological examination revealed lymphocytic vasculitis with fibrinoid necrosis. Etiological explorations searching for vasculitis were negative. In the absence of a precise etiology, drug-induced ulcer was suspected. Low molecular weight heparin was prescribed to replace acenocoumarol. The lesions slowly resolved with topical treatment.
  
  
  CONCLUSIONS
  The chronological criteria and the negativity of etiological explorations allowed the diagnosis of vitamin K antagonist-induced necrotic skin ulcer. Clinicians should be aware of this rare complication induced by oral anticoagulants because of its practical therapeutic implications. This is the first case of necrotic leg ulcer induced by acenocoumarol corresponding histologically to necrotising lymphocytic vasculitis.
authors.affiliation: Service de dermatologie et de vénéréologie, hôpital Arrazi, CHU Mohammed VI, Marrakech, Maroc. Electronic address: houda.chabli@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Chabli
authors.affiliation: Service de dermatologie et de vénéréologie, hôpital Arrazi, CHU Mohammed VI, Marrakech, Maroc.
authors.forename: O
authors.initials: O
authors.lastname: Hocar
authors.affiliation: Service de dermatologie et de vénéréologie, hôpital Arrazi, CHU Mohammed VI, Marrakech, Maroc.
authors.forename: N
authors.initials: N
authors.lastname: Akhdari
authors.affiliation: Service de dermatologie et de vénéréologie, hôpital Arrazi, CHU Mohammed VI, Marrakech, Maroc.
authors.forename: S
authors.initials: S
authors.lastname: Amal
authors.affiliation: Laboratoire ZOHOR d'anatomie et cytologie pathologiques, Marrakech, Maroc.
authors.forename: M
authors.initials: M
authors.lastname: Hakkou
authors.affiliation: Laboratoire ZOHOR d'anatomie et cytologie pathologiques, Marrakech, Maroc.
authors.forename: A
authors.initials: A
authors.lastname: Hamdaoui
mesh_terms: D000074:Acenocoumarol / Q000009:adverse effects* / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D057915:Drug Substitution; D005260:Female; D006495:Heparin, Low-Molecular-Weight; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology; D007871:Leg Ulcer / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D009336:Necrosis; D014657:Vasculitis / Q000139:chemically induced* / Q000150:complications / Q000276:immunology; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K; D000074:Acenocoumarol
keywords: Anticoagulants; Antivitamine K; Effet indésirable; Leg ulcer; Side effect; Ulcère de jambe; Vasculite; Vasculitis; Vitamin K antagonists