Bullous hemorrhagic dermatosis probably associated with enoxaparin

Miguel‐Gomez, Laura; Fonda‐Pascual, Pablo; Carrillo-Gijón, R.; Muñoz-Zato, Ernesto

doi:10.4103/0378-6323.175915

Cited by 7 publications

(12 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Biopsy was done at the largest lesion on right forearm. Sizes of reported bullous hemorrhagic dermatosis in the literature varies from small to large [71114] and the biopsy findings of large bullous hemorrhagic dermatosis have not been published [14]. As far as we know, this is the first case of bullous hemorrhagic dermatosis induced by enoxaparin with bullous pemphigoid.…”

Section: Discussionmentioning

confidence: 99%

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

Shim

Chung

Kim

et al. 2017

Asia Pacific Allergy

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

Shim

Chung

Kim

et al. 2017

Asia Pacific Allergy

View full text Add to dashboard Cite

show abstract

“…[39][40][41] Data of all previous reports included in the study and of our own case were compiled in Table 1. HBHD affected 44 men [1][2][3][4][5][6][7][8][9][10][11]13,17,19,21,23,24,[26][27][28][29][30][31][32][33][34]36 and 16 women, 1,2,6,12,14,22,25,29,35,36 with a male/female rate of 2.75. The age range was from 21 to 94 years, with an average of 70.8 and a median of 72 years.…”

Section: Resultsmentioning

confidence: 99%

“…The lapse of time between the start of heparin and the onset of skin lesion varied from 6 hours to 240 days, with an average of 17.3 days and a median of 7 days. In regard to the topography of the skin lesions, hands were affected in 16 patients, 1,[5][6][7]11,13,14,16,21,24,25,29,31,34 wrists in 1 patient, 24 forearms in 9 patients, 1,5,16,20,29,30,37,38 arms in 8 patients, 6,7,9,10,12,21,23,27 elbows in 1 patient, 20 upper extremities with no other specification in 10 patients, 2,17,18,24,26,28,36 feet in 8 patients, 6,11,12,29,34,35 ankles in 9 patients, 1,3,11,12,…”

Section: Resultsmentioning

confidence: 99%

“…In one case, the site of the lesion was not specified. 33 On histopathology, the level of the blister showed to be subcorneal in 10 patients, 2,3,8,9,13,17,18,29 intraepidermal in 30 patients, 1,[4][5][6]10,11,16,[21][22][23][24][25][26][27][28][29][30]33,36,37 subepidermal in 8 patients 6,7,14,20,29,35,38 , and both intraepidermal and subepidermal in 1 patient. 29 In 33 cases, there was no significant dermal inflammatory infiltrate.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Heparin-Induced Bullous Hemorrhagic Dermatosis: A Report of an Exceptionally Exuberant Case and Literature Review

Almeida

Campos

Daxbacher

et al. 2021

The American Journal of Dermatopathology

View full text Add to dashboard Cite

Introduction: Heparin-induced bullous hemorrhagic dermatosis (HBHD) is an unusual cutaneous adverse reaction to heparin characterized by acute onset of hemorrhagic bullae.Methodology: An exuberant case of HBHD is reported, and a revision of previously reported cases indexed on PubMed is provided. Cases were tabulated to the following parameters: sex, age, type of heparin and route of administration, associated medical procedure, number of days between heparin start and onset of lesions, site of the lesions, level of blister on histopathology, inflammatory infiltrate on histopathology, direct immunofluorescence findings, heparin-related intervention, number of days to resolution of skin lesions, associated hemorrhagic event, and outcome.Case report: A 21-year-old woman with end-stage renal disease was receiving intravenous unfractioned heparin (UFH) during hemodialysis section for the past 3 months. Four hours after using for the first time an arteriovenous fistula punctured on her right wrist, the patient noticed the onset of vesicles and blisters on the right forearm containing citrus or serohemorrhagic exudate, which became overt hemorrhagic in 24 hours. Histopathology depicted a nonacantholytic subcorneal blister containing erythrocytes and plasma without any significant dermal inflammatory infiltrate.Results: Sixty cases of HBHD were included. HBHD affected predominantly men, with a male/female rate of 2.75. The age range was from 21 to 94 years, with an average of 70.8 and a median of 72 years. Nine patients used UFH, and 54 patients used low molecular weight heparins (3 patients used both). The lapse of time between the start of heparin and the onset of skin lesion varied from 6 hours to 240 days, with an average of 17.3 days and a median of 7 days. Limbs were affected in most of the cases. The level of the blister was subcorneal in 10 patients, intraepidermal in 30, subepidermal in 8, and both intraepidermal and subepidermal in 1. In 33 cases, there was no significant dermal inflammatory infiltrate. Pure lymphocytic inflammatory infiltrate was present in 10 cases. Eosinophils were found within the dermal inflammatory infiltrate in 2 cases, neutro-phils in 2, and a mixture of eosinophils and neutrophils in other 2. Direct immunofluorescence was performed in 18 cases, all of them with negative results.Discussion: We hypothesize that mechanical trauma, skin fragility, and the anticoagulation effect of heparin might contribute concomitantly to the development of the lesions and speculate that subepidermal blisters in HBHD could be formed by rupture of the floor of a former intraepidermal blister.

show abstract

“…Bulla is defined as a fluid-filled blister on skin measuring five millimeters or more. Common causes are infection (Vibrio sp, Streptococcal sp), trauma, drugs, burns, porphyria, allergy (contact dermatitis), bullous pemphigoid and malignancy [1,2]. The color of the bulla depends on the etiology, e.g., infection-related bullae can be white, yellow or red, while traumatic bullae are usually red (hemorrhagic).…”

Section: Dear Editormentioning

confidence: 99%