Remote Hemorrhagic Bullae Occurring in a Patient Treated With Subcutaneous Heparin

Gonzales, Urvi Pajvani; Scott, Glynis; Briones, Alice J.; Pentland, Alice P.

doi:10.1001/archdermatol.2009.70

Cited by 28 publications

(27 citation statements)

References 5 publications

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“…[4] and Gonzales et al . [5] reported a total of three cases similar to those described by Perrinaud et al . [3] and they were associated with the administration of enoxaparin sodium.…”

Section: Discussionsupporting

confidence: 64%

Bullous hemorrhagic dermatosis: A case report

Naveen

Rai

2014

Indian J Dermatol

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We present a case of hemorrhagic bullous dermatosis occurring in areas distant from the site of injection of enoxaparin. A 88 year old woman was admitted for inter trochantric fracture. She was put enoxaparin 60mg subcutaneous 12 hrly for deep vein thrombosis. After 5 days she developed huge hemorrhagic bulla on left leg and multiple hemorrhagic bullae at other sites distant from injected site. A diagnosis of Bullous hemorrhagic dermatoses due to enoxaparin was made. Enoxaparin was stopped and started on oral heparin. Lesions started to regress. Only 9 similar cases have been reported throughout world and none from India.

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“…[4] and Gonzales et al . [5] reported a total of three cases similar to those described by Perrinaud et al . [3] and they were associated with the administration of enoxaparin sodium.…”

Section: Discussionsupporting

confidence: 64%

Bullous hemorrhagic dermatosis: A case report

Naveen

Rai

2014

Indian J Dermatol

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“…Blood-filled intraepidermal or subcorneal vesicles and blisters with no signs of vasculitis or capillary thrombosis have been reported [11]. Infiltration of inflammatory cells such as eosinophil or neutrophil was not definite, and direct immunofluorescence test result is usually negative [8910]. Although we did not check antiplatelet factor 4/heparin antibodies in skin biopsy specimens, it has been reported that antiplatelet factor 4/heparin antibodies were usually negative [10].…”

Section: Discussionmentioning

confidence: 98%

“…Since then, less than 20 cases have been reported worldwide. Bullous hemorrhagic dermatosis occurs at a distance from the heparin injection site and mainly occurs in limbs and abdomen [789]. Tense, hemorrhagic bullae occur without other accompanying symptoms such as itching sense, pain [10].…”

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

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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.

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“…The cause of this reaction remains unknown and only 7 confirmed cases have been published to date. [1][2][3][4] We present 5 new cases and discuss some possible triggering factors.…”

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confidence: 97%

“…Lymphomaassociated HPS in primary cutaneous lymphoma is also associated with the Asian variant of intravascular large B-cell lymphoma (BCL) and subcutaneous panniculitic T-cell lymphoma and . 2, 3 We report an unusual case of HPS occurring months before the manifestation of primary cutaneous diffuse large BCL leg type. A 62-year-old man presented with high-grade fever, loss of appetite, and loss of weight of 2 months' duration.…”

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confidence: 97%