Faculty of Medicine, Cairo University Kasr Alainy, Cairo, Egypt.
Tufts University, Boston, USA.
J Thromb Thrombolysis. 2020 Jan;49(1):149-152. doi: 10.1007/s11239-019-01924-8.
Warfarin is one of the most commonly used anticoagulants in the management of thromboembolic events. Herein we report a rare case of warfarin induced leukocytoclastic vasculitis in a patient with history of rheumatic heart disease and a mechanical mitral valve prosthesis who presented with heart failure and palpable purpura. Upon clinical suspicion of cutaneous small vessel vasculitis, a comprehensive laboratory panel was performed. Warfarin induced vasculitis was suspected when withdrawal of warfarin, due to rising INR, led to improvement of the skin lesions. The diagnosis was finally confirmed when re-instatement of warfarin reproduced the skin lesions and a skin biopsy showed evidence for leukocytoclastic vasculitis with eosinophilic infiltration. A third of cases of leukocytoclastic vasculitis are due to drug hypersensitivity which being a diagnosis of exclusion with varying manifestations, requires a high index of clinical suspicion. Since drug induced leukocytoclastic vasculitis may affect multiple organ systems and even cause mortality, clinicians must be aware of this rare adverse event, promptly discontinue the drug, and commence anti-inflammatory or immunosuppressive treatment when necessary.
华法林是血栓栓塞性事件管理中最常用的抗凝剂之一。本文报告了 1 例风湿性心脏病和机械二尖瓣假体病史患者发生华法林诱导的白细胞碎裂性血管炎的罕见病例，该患者表现为心力衰竭和可触及性紫癜。当临床怀疑皮肤小血管血管炎时，进行了全面的实验室检查。由于 INR 升高停用华法林后，皮肤病变改善，怀疑为华法林诱导的血管炎。当重新开始使用华法林时，皮肤病变重现，皮肤活检显示白细胞碎裂性血管炎伴嗜酸性粒细胞浸润，从而最终确诊。白细胞碎裂性血管炎有三分之一是由于药物过敏引起的，这种疾病的诊断需要排除其他各种表现，因此需要高度的临床怀疑。由于药物诱导的白细胞碎裂性血管炎可能影响多个器官系统，甚至导致死亡，因此临床医生必须意识到这种罕见的不良反应，及时停用药物，并在必要时进行抗炎或免疫抑制治疗。
