Warfarin induced benign acral cutaneous lesions in two cardiac patients with decreased protein C and S activity/Protein C ve S aktiviteleri dusuk olan iki kalp hastasinda gorulen warfarin'e bagli selim uzuv derisi dokuntuleri.

We have presented two cardiac patients with protein C and S deficiency who were admitted with benign warfarin related cutaneous lesions. First case was a 60-year-old man. He was admitted with a transient ischemic attack. An anticoagulant treatment was begun with 2.5 mg warfarin once a day. After 3 days, he was re-admitted with development of skin lesions, which were painless, papular and vesicular or bullous, 2 to 25 mm in diameter, dark purple in color, and involving specifically upper and lower limbs distal to the ankle and knee joints (Fig. 1). Gross hematuria also occurred on the 4th day of hospitalization due to coagulopathy. Second case was a 51-year-old woman with rheumatic heart disease, which was treated with mitral commissurotomy 8 years ago. She complained on numbness on both arms for one hour. Warfarin 5 mg once a day was administered together with enoxaparine. On the 4th day, small dark purple lesions appeared mainly on the skin of hands and feet (Fig. 2). Pathological examination of the lesions has shown capillary dilatation with mild perivascular lymphocytic infiltration and subcorneal hematoma. There was spontaneous and substantial healing of the skin lesions during the next few days in both cases. We suggested "atypical warfarin induced skin necrosis" for the definition of the lesions. However, we are not sure that these lesions might be a precursor of typical warfarin induced skin necrosis. The treatment of these benign acral cutaneous lesions might be discontinuation of warfarin treatment and initiation of heparin.

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Mutlu Vural, Servet Usta *, Rabia Kaya **

From Clinics of Cardiology, * Dermatology and ** Pathology, Kirsehir State Hospital, Kirsehir, Turkey

Address for Correspondence/Yazi.ma Adresi: Dr. Mutlu Vural Bayar cad. Pinar sok. Catalpinar Sitesi B8/27 Kozyatagi, Istanbul, Turkey Mobile: [phone] E-mail: [e-mail]