Warfarin-induced Leukocytoclastic Vasculitis: A Case Report and Review of Literature

Abstract

Warfarin is widely prescribed for patients with atrial fibrillation. In addition to unexpected bleeding, allergic skin reaction is one of its uncommon adverse effects. We herein report an 89-year-old man who, after taking warfarin for 4 years, suffered extensive skin eruptions. The skin biopsy disclosed leukocytoclastic vasculitis. The causal relationship between skin lesions and warfarin was confirmed after re-challenge of warfarin. A literature review revealed only 13 such cases reported from 1980 to 2011. Clinicians should be aware of this potential adverse effect of warfarin.

Multidrug-related leukocytoclastic vasculitis raising suspicion of sexual homicide—things are not always what they seem

“…The exact pathogenesis is unclear, but it is thought that subsequent activation of the complement system produces vascular injury and extravasation of erythrocytes. Common causes of LCV include infections, connective tissue diseases, malignancies, autoimmune diseases, cocaine abuse, and intake of various therapeutic drugs (e.g., allopurinol, erythromycin, hydantoin, indomethacin, penicillin, phenylbutazone, sulfonamides, and thiazide diuretics) [8,14,15]. The classic presentation of LCV is palpable purpura, papules, and bullae ranging from erythematous lesions to deep ulcers or digital gangrene [12].…”

“…Although the cutaneous features of LCV are highly variable, almost all skin lesions appear in a symmetrical distribution pattern [17]. The histopathology of purple skin discoloration from the face, knees, and hips revealed perivascular neutrophilic infiltrates with extensive leukostasis and red blood cell extravasation in the subcutaneous tissue, all features characteristic of LCV [14,15]. Because histology revealed neither blistering nor necrosis of the skin, TEN, characterized by bullous mucocutaneous eruptions and massive epidermal detachment [11,[18][19][20][21], could be ruled out as the underlying pathological condition responsible for the skin lesions observed here.…”

Nafcillin Implicated in A Case of Cutaneous and Gastrointestinal Leukocytoclastic Vasculitis

“…Keywords: Biopsy, Endoscopy, Hypersensitive, Gastrointestinal Certain infections, such as Staphylococcus aureus, hepatitis B and C and HIV, may be associated with this disorder [2][3][4][5]. Some diseases, such as malignancies [6] and collagen vascular diseases [7], may also have this presentation on the skin.…”

Henoch-Schonlein Purpura After Warfarin Usage in an Adult Patient with Mitral Valve Replacement: Case Report

“…[2][3][4][5]9 İlaç kullanımı ve HSP oluşumu arasındaki sürenin günler (üç gün), aylar ve yıllar (12 yıl) arasında değişmekte olduğu literatürde bildirilmektedir. 10,11 Olgumuza iki ay önce mitral kapak replasmanı operasyonu uygulanmıştı. Varfarine başlama ile HSP'nin oluşumu arasında yaklaşık 1,5 aylık bir süre vardı.…”

“…Her iki grupta ise histopatolojik olarak anlamlı hiçbir fark görülmemektedir. 5,[9][10][11] HSP tanısında direkt immünfloresan (DIF) yöntemi ile damar duvarında IgA'nın birikiminin gösterilmesi kesin tanıyı koydurmaktadır. Ancak döküntünün ilk 24-48 saati içinde alınan cilt biyopsilerinde bu gösterilebilmekte, daha geç alındı-ğında kaybolabilmektedir.…”