Kurihara F, Tella E, Sigal M-L, Mahé E
Service de dermatologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95100 Argenteuil, France.
Service de dermatologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel-Prudhon, 95100 Argenteuil, France.
Rev Med Interne. 2018 Jan;39(1):50-53. doi: 10.1016/j.revmed.2017.08.001. Epub 2017 Sep 1.
Patients treated by vitamin K antagonists (VKA) represent 1% of the population in France. We report a case of atypical necrotic leg ulcers induced by VKA.
A 84-year-old woman was referred to our dermatology department because of necrotic leg ulcers that developed for the past 5weeks, and appeared spontaneously after the introduction of a VKA, fluindione. The etiological assessment was non contributive, in particular the search for thrombophilic factors. The skin biopsy found an aspect compatible with pyoderma gangrenosum. The outcome was favorable after discontinuing the fluindione and the switch to apixaban. A complete healing was obtained in 5months.
We report an original case of necrotic leg ulcers induced by VKA without deficit of protein C or S, with a pyoderma like histology. Reported cases of ulcers induced by VKA are uncommon and the physiopathology is not well known. The involvement of VKA should be evoked in case of necrotic leg ulcer without specific etiology found.
在法国，接受维生素K拮抗剂（VKA）治疗的患者占总人口的1%。我们报告一例由VKA引起的非典型坏死性腿部溃疡病例。
一名84岁女性因腿部坏死性溃疡被转诊至我们的皮肤科，该溃疡在过去5周内出现，在开始使用VKA氟茚二酮后自发出现。病因评估无结果，特别是对血栓形成倾向因素的检查。皮肤活检发现与坏疽性脓皮病相符的表现。停用氟茚二酮并改用阿哌沙班后，结果良好。5个月后完全愈合。
我们报告一例由VKA引起的坏死性腿部溃疡的原始病例，无蛋白C或S缺乏，组织学表现类似坏疽性脓皮病。VKA引起溃疡的报道病例并不常见，其病理生理学尚不清楚。在未发现特定病因的坏死性腿部溃疡病例中，应考虑VKA的影响。
