A 52-year-old woman with widespread multiple myeloma was referred with an 8-hour history of spreading cellulitis with a central dusky purple area over her lower anterior abdominal skin. There was no crepitus or foul watery discharge although the central area was starting to blister. She was awaiting orthopaedic assessment of cervical spine stability because of tumour infiltration at C5 and C6 levels. She was also being treated for a deep vein thrombosis with warfarin. However, the warfarin had been stopped in error 2 weeks previously, and then restarted 4 days before this episode. She had been commenced on warfarin originally because of a pulmonary embolus following the first course of chemotherapy for treatment of her multiple myeloma.
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