Patel Dhruvkumar M, Patel Mukundkumar V, Patel Akash D, Kaklotar Jignesh C, Patel Greshaben R, Patel Maitri M
N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India.
Zydus Medical College and Hospital, Dahod, Gujarat, India.
Curr Drug Saf. 2019;14(3):246-248. doi: 10.2174/1574886314666190304094407.
Calciphylaxis is a complex dermatological lesion of micro vascular calcification that is typically presented as panniculitis with gangrenous painful lesions having uremic and non-uremic causes.
We present a case of a 48-year old male with a history of paroxysmal atrial fibrillation and hypertension taking amlodipine 5 mg and warfarin 5 mg daily for the last 26 months. The patient had a 6- months history of painful swelling followed by necrotic skin ulcer over the right leg. His remarkable examination findings were right leg tender ulcer with surrounding erythema and secondary sepsis. His hemogram, metabolic profile and connective tissue diseases work up were unremarkable except leucocytosis and raised inflammatory markers. His local part radiological and skin biopsy findings were suggestive of calciphylaxis.
In our case, warfarin and amlodipine were culprit drugs for the lesion, but Naranjo score (warfarin 7and amlodipine 1) speculate warfarin as a probable adverse reaction of warfarin. The lesion was cured with local wound treatment after discontinuation of warfarin. The physician should be aware of this rare cutaneous disorder of systemic origin for proper management.
钙化防御是一种微血管钙化的复杂皮肤病损，通常表现为脂膜炎，伴有坏疽性疼痛性皮损，病因包括尿毒症性和非尿毒症性。
我们报告一例48岁男性，有阵发性心房颤动和高血压病史，在过去26个月中每天服用5毫克氨氯地平和5毫克华法林。患者有6个月的右下肢疼痛性肿胀病史，随后出现坏死性皮肤溃疡。其显著的检查结果为右下肢压痛性溃疡，周围有红斑及继发性脓毒症。除白细胞增多和炎症标志物升高外，其血常规、代谢指标及结缔组织病检查均无异常。其局部放射学及皮肤活检结果提示钙化防御。
在我们的病例中，华法林和氨氯地平是导致该病变的罪魁祸首药物，但根据纳兰霍评分（华法林评分为7，氨氯地平评分为1）推测华法林是可能的不良反应原因。停用华法林后，通过局部伤口治疗，病变得以治愈。医生应了解这种罕见的全身性皮肤疾病以便进行恰当处理。
