Bullous hemorrhagic dermatosis due to enoxaparin use in a bullous pemphigoid patient

Abstract

Adverse reactions of subcutaneous low molecular weight heparin or unfractionated heparin could be complications by bleeding, heparin-induced thrombocytopenia, drug-induced liver injury, osteoporosis, and cutaneous reactions. Heparin-induced skin lesions vary from allergic reactions like erythema, urticaria, eczema to intradermal microvascular thrombosis associated with heparin-induced thrombocytopenia. There is a rare cutaneous complication, called bullous hemorrhagic dermatosis. We experienced this rare case of the cutaneous complication caused by enoxaparin. Several tense bullous hemorrhagic lesions occurred after 3 days of enoxaparin in a known bullous pemphigoid patient who had aortic valve replacement surgery with a mechanical prosthesis. The bullous hemorrhagic lesions were regressed after the discontinuation of enoxaparin but recurred after re-administration. The lesions were controlled by the administration of systemic corticosteroid and alternative anticoagulant. To date, less than 20 cases have been reported worldwide. This is the first case of bullous hemorrhagic dermatosis induced by enoxaparin, a low-molecular-weight heparin in Korea. This is also the first case of bullous hemorrhagic dermatosis in a known bullous pemphigoid patient.

Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature

“…After the appearance of BHD, maintaining anticoagulation with a LMWH may increase a patient’s risk of recurrent bullae [ 21 , 22 , 31 ]. Nevertheless, 21 patients in our review continued on anticoagulation with a LMWH without report of recurrence.…”

Postpartum eruption of enoxaparin‐induced erythema multiforme

“…Rarely, reports of bullous hemorrhagic dermatosis and drug reaction with eosinophilia and systemic symptoms syndrome are described. 2,3 To our knowledge no cases of enoxaparin-induced erythema multiforme have been described. Erythema multiforme is an acute mucocutaneous condition that classically presents with targetoid lesions.…”

“…A less common but recognized risk is heparin‐induced thrombocytopenia resulting from antibodies against heparin/platelet factor‐4. Rarely, reports of bullous hemorrhagic dermatosis and drug reaction with eosinophilia and systemic symptoms syndrome are described . To our knowledge no cases of enoxaparin‐induced erythema multiforme have been described.…”

Hemorrhagic Bullous Dermatosis Associated With Low Molecular Weight Heparin: A Case Report

“…(6) 72 yaşındaki olgusunda da enoxaparin tedavisi kesildikten 1 hafta sonra lezyonlar da kendiliğinden gerilemiştir. Bülloz pemfigoid hastasında enoksaparine bağlı gelişen hemorajik büllöz dermatoz ise sistemik kortikosteroid ve farklı antikoagülan tedavi ile gerilemiştir (7) . Olgumuzda da enoksaparin tedavisinin kesilmesinden 7 gün sonra lezyonlar kendiliğinden geriledi.…”