Warfarin
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Calciphylaxis: case report A 58-year-old woman, with type 2 diabetes mellitus, developed calciphylaxis during treatment with warfarin [dosage not stated] for atrial fibrillation. The woman, who had been receiving warfarin for 5 months, presented with a 2-month history of painful black areas on both of her calves. The lesions had been preceded, 1 month earlier, by mottling of the skin in the affected regions. Examination revealed widespread necrotic ulcerated lesions on both legs, surrounded by erythematous areas of livedoid reticularis; she was pale and in significant discomfort. Tests showed a low haemoglobin level (98 g/L), a slightly elevated Creactive protein level (16 mg/L) and an elevated antinuclear antibody level with a coarse speckled pattern (titre 1:320). Xrays revealed marked and extensive calcification of her femoral, posterior tibial and popliteal vessels; calcified arteries were seen by Doppler ultrasound. Calciphylaxis was diagnosed from a punch biopsy. Warfarin was replaced with heparin. However, the woman’s condition continued to deteriorate and a further biopsy revealed ulceration with widespread calcification. She received prednisolone, minocycline, morphine and gabapentin. Manuka honey dressings were applied to the ulcers and SC insulin was started. She had minimal improvement and, after 1 month, received pentoxifylline. Within a few weeks, her condition had improved significantly. Minocycline was discontinued due to abdominal symptoms. The manuka honey dressings were replaced with hydrogel silver dressings once the necrotic scabs had lifted. Her ulcers had healed completely approximately 8 months after her presentation and she was weaned off prednisolone. Asobie N, et al. Calciphylaxis in a diabetic patient provoked by warfarin therapy. Clinical and Experimental Dermatology 33: 342-344, No. 3, May 2008 801111029 England
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Reactions 31 May 2008 No. 1204
