Chabli H, Hocar O, Akhdari N, Amal S, Hakkou M, Hamdaoui A
Service de dermatologie et de vénéréologie, hôpital Arrazi, CHU Mohammed VI, Marrakech, Maroc.
Service de dermatologie et de vénéréologie, hôpital Arrazi, CHU Mohammed VI, Marrakech, Maroc.
J Mal Vasc. 2015 Dec;40(6):402-5. doi: 10.1016/j.jmv.2015.10.002. Epub 2015 Nov 11.
Vitamin K antagonists are widely used in thromboembolic diseases. Hemorrhagic complications related to drug overdose represent their main side effect. We report a rare side effect, a severe and unexpected type of skin vasculitis - necrotic leg ulcer - induced by vitamin K antagonist.
A 63-year-old female with a history of diabetes developed hyperalgesic necrotic ulcerations on the lower limbs one month after starting an acenocoumarol-based treatment for ischemic heart disease. Histological examination revealed lymphocytic vasculitis with fibrinoid necrosis. Etiological explorations searching for vasculitis were negative. In the absence of a precise etiology, drug-induced ulcer was suspected. Low molecular weight heparin was prescribed to replace acenocoumarol. The lesions slowly resolved with topical treatment.
The chronological criteria and the negativity of etiological explorations allowed the diagnosis of vitamin K antagonist-induced necrotic skin ulcer. Clinicians should be aware of this rare complication induced by oral anticoagulants because of its practical therapeutic implications. This is the first case of necrotic leg ulcer induced by acenocoumarol corresponding histologically to necrotising lymphocytic vasculitis.
维生素K拮抗剂广泛应用于血栓栓塞性疾病。与药物过量相关的出血并发症是其主要副作用。我们报告了一种罕见的副作用，即维生素K拮抗剂诱发的严重且意外的皮肤血管炎类型——坏死性腿部溃疡。
一名63岁患有糖尿病的女性，在开始基于醋硝香豆素治疗缺血性心脏病一个月后，下肢出现痛觉过敏的坏死性溃疡。组织学检查显示为伴有纤维蛋白样坏死的淋巴细胞性血管炎。针对血管炎的病因学检查结果为阴性。在没有确切病因的情况下，怀疑是药物性溃疡。于是停用醋硝香豆素并使用低分子量肝素。经局部治疗后，病变逐渐消退。
根据时间顺序标准以及病因学检查结果阴性，诊断为维生素K拮抗剂诱发的坏死性皮肤溃疡。由于其实际的治疗意义，临床医生应意识到这种由口服抗凝剂引起的罕见并发症。这是首例组织学上与坏死性淋巴细胞性血管炎相符的由醋硝香豆素诱发的坏死性腿部溃疡病例。
