+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Recurrent pyoderma gangrenosum-like ulcers induced by oral anticoagulants

Recurrent pyoderma gangrenosum-like ulcers induced by oral anticoagulants

Annales de Dermatologie et de Venereologie 141(1): 34-38

Other than the classic skin necrosis induced by oral anticoagulants (OAC) in patients with protein C and S deficiencies, other types of OAC induced-skin ulcers are little known. Herein, we describe an original case of recurrent pyoderma gangrenosum (PG)-like ulcers induced by OAC. A 70-year-old female heart-transplant recipient presented deep, hyperalgesic and quickly-spreading necrotic ulceration of the right leg 6 weeks after starting oral anticoagulant therapy with fluindione. Histological analysis revealed dermal infiltrate containing polynuclear neutrophils, which accords with the histopathological diagnosis of leukocytoclastic vasculitis or PG. Infectious, autoimmune and thrombophilic causes were ruled out. Fluindione was withdrawn and the ulcer healed completely within a month. Six months later, right leg ulceration recurred two weeks after the patient resumed fluindione but healed within 1 month of discontinuation of the drug. An OAC from another chemical family (warfarin) was then introduced, with further recurrence of ulceration after 2 weeks of treatment. The chronology of events and the negativity of aetiological explorations allowed a diagnosis to be made of OAC-induced skin ulcer, a rare complication of which the pathophysiology is unclear. This is the first case of PG-like ulcers induced by OAC.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 055420876

Download citation: RISBibTeXText

PMID: 24461092

DOI: 10.1016/j.annder.2013.09.159

Related references

Skin ulcers associated with a tender and swollen arm. Pyoderma gangrenosum (PG) in association with chronic recurrent multifocal osteomyelitis (CRMO). Archives of Dermatology 134(9): 1146-7, 1149-50, 1998

Case for diagnosis recurrent ulcers abstract human pyoderma gangrenosum scar formation joint deformity histology. Japanese Journal of Dermatology 77(2): 182, 1968

Drug-induced pyoderma gangrenosum: a model to understand the pathogenesis of pyoderma gangrenosum. British Journal of Dermatology (): -, 2016

Case of pyoderma gangrenosum showing oral and genital ulcers, misdiagnosed as Behcet's disease at first medical examination. Journal of Dermatology 35(5): 289-292, 2008

Hydralazine-induced systemic lupus erythematosus presenting as pyoderma gangrenosum-like ulcers. Journal of the American Academy of Dermatology 10(2 Pt 2): 379-384, 1984

Misdiagnosed Periocular Pyoderma Gangrenosum Requiring Ectropion Repair With Development of Second Lesion of Pyoderma Gangrenosum at Graft Site. JAMA Dermatology 152(4): 491-492, 2016

"Pyoderma (ecthyma) gangrenosum" by Brunsting, Goeckerman and O'Leary, October 1930. Commentary: Pyoderma gangrenosum. Archives of Dermatology 118(10): 743-773, 1982

The efficacy of topical 0.2% hyaluronic acid gel on recurrent oral ulcers: comparison between recurrent aphthous ulcers and the oral ulcers of Behçet's disease. Journal of the European Academy of Dermatology and Venereology 22(5): 590-595, 2007

Targeted treatment of pyoderma gangrenosum in PAPA (pyogenic arthritis, pyoderma gangrenosum and acne) syndrome with the recombinant human interleukin-1 receptor antagonist anakinra. British Journal of Dermatology 161(5): 1199-1201, 2010

Skin ulcers misdiagnosed as pyoderma gangrenosum. New England Journal of Medicine 348(11): 1064-6; Author Reply 1064-6, 2003

Painful ulcers of the scrotum. Pyoderma gangrenosum (PG). Archives of Dermatology 131(5): 609, 612-609, 612, 1995

Management of vasculitic leg ulcers and pyoderma gangrenosum. Current Problems in Dermatology 27: 277-285, 1999

Skin ulcers misdiagnosed as pyoderma gangrenosum. New England Journal of Medicine 347(18): 1412-1418, 2002

Use of Becaplermin for nondiabetic ulcers: pyoderma gangrenosum and calciphylaxis. Dermatologic Therapy 29(2): 104-108, 2015

Cavitating ulcers--pyoderma gangrenosum of the anal canal?. Gastroenterology 95(4): 1158-1159, 1988