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The International Journal of Lower Extremity Wounds
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Nonpalpable Purpura Within a Setting of Anticoagulant Therapy and Metastatic Carcinoma

Nicole Grenier, BS

Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Providence, RI

Catherine Chen-Tsai, MD

Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Providence, RI, cpctsai1{at}yahoo.com

The anticoagulant warfarin can produce a skin necrosis that is clinically indistinguishable from the skin necrosis caused by purpura fulminans associated with disseminated intravascular coagulation (DIC) and heparin-induced thrombocytopenia (HIT). The similar clinical and histologic findings observed in each of these skin necroses create a challenge for diagnosis and eventual treatment. The authors report a patient with significant risk factors for warfarin-induced skin necrosis, DIC, and HIT presenting with painful, purpuric patches beginning on her feet and extending proximally before becoming hemorrhagic bullae on her lower extremities.

Key Words: warfarin-induced skin necrosis • heparin-induced thrombocytopenia • disseminated intravascular coagulopathy

The International Journal of Lower Extremity Wounds, Vol. 5, No. 3, 200-203 (2006)
DOI: 10.1177/1534734606290920
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