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华法林致抗磷脂综合征患者单侧乳腺大面积坏死:一例报告

Warfarin-induced major unilateral breast necrosis in a patient with antiphospholipid syndrome: A case report.

作者信息

AlQhtani Abdullh, AlSahabi Abdulrahman, Ashammery Ahmad

机构信息

Plastic Surgery, General Surgery Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia.

Plastic Surgery Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.

出版信息

Int J Surg Case Rep. 2020;77:656-659. doi: 10.1016/j.ijscr.2020.11.111. Epub 2020 Nov 23.

Abstract

INTRODUCTION

Warfarin-induced necrosis is a rare complication associated with the use of warfarin in addition to antiphospholipid syndrome.

CASE PRESENTATION

A 50-year-old female patient with a known case of antiphospholipid syndrome started warfarin treatment for ischaemic changes in her toes and subsequently experienced warfarin-induced necrosis in her left breast. Then, warfarin treatment was suspended, and she was started on enoxaparin. Debridement was performed, and a skin graft was applied without complications.

DISCUSSION

Skin necrosis has many differential diagnoses, and physicians must take a proper history and perform a physical examination with proper investigations involving a multidisciplinary team, including plastic surgery, haematology, internal medicine, and wound care specialists. Plastic surgery offers many options for reconstruction depending on the patient's medical condition, the size of the wound and the location following the reconstructive ladder.

CONCLUSION

This case report presents a rare complication of warfarin in the context of antiphospholipid syndrome and describes the management of unilateral breast necrosis. Physicians should be highly suspicious of this condition in patients with skin necrosis who were administered warfarin or have antiphospholipid syndrome.

摘要

引言

华法林诱导的坏死是一种罕见的并发症,与华法林的使用以及抗磷脂综合征有关。

病例介绍

一名已知患有抗磷脂综合征的50岁女性患者,因脚趾缺血性改变开始接受华法林治疗,随后左侧乳房出现华法林诱导的坏死。随后,华法林治疗被暂停,她开始使用依诺肝素。进行了清创术,并进行了皮肤移植,未出现并发症。

讨论

皮肤坏死有许多鉴别诊断,医生必须详细询问病史并进行体格检查,同时进行适当的检查,涉及多学科团队,包括整形外科、血液学、内科和伤口护理专家。根据患者的病情、伤口大小和位置,整形外科可根据重建阶梯提供多种重建选择。

结论

本病例报告介绍了抗磷脂综合征背景下华法林罕见的并发症,并描述了单侧乳房坏死的处理方法。对于接受华法林治疗或患有抗磷脂综合征且出现皮肤坏死的患者,医生应高度怀疑这种情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ac6/7708858/9d1bc1429545/gr1.jpg

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