[Skin necrosis with vitamin K antagonists: An imbalance between coagulant and anticoagulant factors].
BACKGROUND
Skin necrosis with vitamin k antagonists are rare. They affect more frequently middle-aged and obese women, often within 10 days after initiating of treatment. They occur most often in a context of thrombophilia.


METHODS
An 18-year-old obese woman was treated with heparin and fluindione for a lower limb deep venous thrombosis. On day 5, the patient presented fever and skin necrosis, which extended rapidly. We identified an activated protein C resistance and a major inflammatory syndrome related to Mycoplasma pneumoniae infection. The outcome was favorable after discontinuation of the fluindione, introduction of heparin and vitamin K, despite amputation of a toe.


CONCLUSIONS
Skin necrosis is due to a transient hypercoagulable state during the initiation of vitamin K antagonist treatment due to an imbalance between pro- and anticoagulant factors. In our case, it was caused by an activated protein C resistance and an inflammatory syndrome.
Service de dermatologie, centre hospitalier, 194, avenue Rubillard, 72000 Le Mans, France. Electronic address: sophie.vildy@outlook.fr.
S
S
Vildy
Service de médecine interne, centre hospitalier, 194, avenue Rubillard, 72000 Le Mans, France.
K
K
Osmaeva
Service de médecine interne, centre hospitalier, 194, avenue Rubillard, 72000 Le Mans, France.
F
F
Closs-Prophette
Service de dermatologie, centre hospitalier, 194, avenue Rubillard, 72000 Le Mans, France.
H
H
Maillard
D015110:4-Hydroxycoumarins / Q000009:adverse effects*; D000293:Adolescent; D000671:Amputation, Surgical; D000925:Anticoagulants / Q000097:blood*; D001940:Breast / Q000187:drug effects / Q000473:pathology; D003029:Coagulants / Q000097:blood*; D005260:Female; D006214:Hallux / Q000473:pathology* / Q000601:surgery; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007192:Indenes / Q000009:adverse effects*; D009336:Necrosis / Q000139:chemically induced; D010630:Phenindione / Q000031:analogs & derivatives / Q000627:therapeutic use; D012867:Skin / Q000187:drug effects* / Q000473:pathology*; D014812:Vitamin K / Q000009:adverse effects / Q000037:antagonists & inhibitors*
D015110:4-Hydroxycoumarins; D000925:Anticoagulants; D003029:Coagulants; D007192:Indenes; C011664:antivitamins K; D014812:Vitamin K; D010630:Phenindione; D006493:Heparin; C017673:fluindione
Activated protein C resistance; Anti-vitamines K; Deep venous thrombosis; Mycoplasma pneumoniae; Nécrose cutanée; Résistance à la protéine C activée; Skin necrosis; Thrombose veineuse; Vitamin K antagonist