The anticoagulant warfarin can produce a skin necrosis that is clinically indistinguishable from the skin necrosis caused by purpura fulminans associated with disseminated intravascular coagulation (DIC) and heparin-induced thrombocytopenia (HIT). The similar clinical and histologic findings observed in each of these skin necroses create a challenge for diagnosis and eventual treatment. The authors report a patient with significant risk factors for warfarin-induced skin necrosis, DIC, and HIT presenting with painful, purpuric patches beginning on her feet and extending proximally before becoming hemorrhagic bullae on her lower extremities.
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, West M, Miech DJ, Mazza JJ.Atypical purpura fulminans with benign monoclonal gammopathy. Arch Dermatol1978;114: 578-580.
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, James W, Berger T.Contact dermatitis and drug eruptions. In: Andrews’ diseases of the skin, clinical dermatology. 9th ed.Philadelphia: W. B. Saunders; 2000. p. 130-131.
