Suliman Alsadig, Ali Siddig, Suliman Hiba, Mohammed Ali Shorouq, Mohamed Osman Reem
Department of General Surgery, Sudan Medical Specialization Board, Isbitalia Street, Downtown, Khartoum, Khartoum 13315, Sudan.
Department of General Surgery, Wad Medani College of Medical Sciences & Technology, Darja Street, Wad Madani, Wad Madani 21111, Sudan.
Oxf Med Case Reports. 2025 May 28;2025(5):omaf047. doi: 10.1093/omcr/omaf047. eCollection 2025 May.
Warfarin-induced skin necrosis (WSN) is a rare but serious complication of anticoagulation therapy. This case report describes a 34-year-old male with mechanical heart valves on long-term warfarin therapy who developed WSN after self-medicating with a doubled warfarin dose following a two-week interruption due to limited healthcare access in a conflict-affected region. Concurrently, he was diagnosed with dengue fever, further complicating anticoagulation management due to thrombocytopenia. Prompt discontinuation of warfarin, intravenous vitamin K administration, and delayed initiation of enoxaparin after platelet recovery were key aspects of treatment. Surgical debridement of necrotic skin lesions was performed, resulting in stabilization and recovery. This case highlights the unique diagnostic and management challenges of WSN in the setting of a concurrent dengue infection, especially in resource-limited settings and conflict-affected areas. Early recognition and tailored intervention are essential to prevent severe complications and improve outcomes.
华法林诱导的皮肤坏死（WSN）是抗凝治疗中一种罕见但严重的并发症。本病例报告描述了一名34岁男性，长期接受华法林治疗以维持机械心脏瓣膜功能，在因受冲突影响地区医疗资源有限而中断治疗两周后自行加倍服用华法林剂量，随后发生了WSN。同时，他被诊断为登革热，由于血小板减少，抗凝管理更加复杂。迅速停用华法林、静脉注射维生素K以及在血小板恢复后延迟开始使用依诺肝素是治疗的关键方面。对坏死皮肤病变进行了手术清创，最终病情稳定并康复。本病例突出了在同时感染登革热的情况下，尤其是在资源有限的环境和受冲突影响地区，WSN独特的诊断和管理挑战。早期识别和针对性干预对于预防严重并发症和改善预后至关重要。
