Bullous Hemorrhagic Dermatosis Induced By Heparin: An Indonesian Case Report
Syahfori Widiyani
Department of Dermato-Veneaorology, Faculty of Medicine, Universitas Kristen Indonesia, Indonesia and Department of Dermato-Veneaorology, Sentra Medika Cisalak Hospital, Depok-Indonesia.
Irsalina Rahmawati *
Department of Dermato-Veneaorology, Sentra Medika Cisalak Hospital, Depok-Indonesia.
W. Yohannes Widodo
Department of Dermatology and Veneorology, Tumor and Skin Surgery Subdivision, RSUP Dr. Sardjito, Yogyakarta, Indonesia.
Dian Zamroni
Department of Cardiology and Vascular Medicine, National Cardiac Center, Harapan Kita, Jakarta-Indonesia.
Fajar L. Gultom
Department of Pathology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta-Indonesia.
Forman Erwin Siagian
Department of Parasitology, Universitas Kristen Indonesia, Jakarta-Indonesia.
Hardi Hutabarat
Resident Medical Officer, Siloam Hospital Lippo Village, Tangerang, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Bullous haemorrhagic dermatosis is a rare clinical disorder which is usually related to a treatment with unfractionated heparin (UFH) or low molecular weight heparin (LMWH), characterized by multiple intra-epidermal haemorrhages distant from the site of injection.
Presentation of Case: A 62-year-old male patient with coronary heart disease who received heparin treatment experienced several tense, haemorrhagic bullae located on the right arm area, close to the injection site, and followed by the formation of several hematomas on his back trunk 2 days after he had received UFH. The lesions regressed after discontinuation of heparin and supportive topical treatments.
Discussion: The lesions in this patient have similar characteristic with heparin-induced skin necrosis and demonstrate thrombocytopenia probably related to heparin. There are some proposed hypotheses of pathophysiology which include hypersensitivity reaction and idiosyncratic dose-related reaction. Given the clinically course, the discontinuation of heparin treatment was essential for lesion regression in addition other supportive measures.
Conclusion: Heparin-induced skin lesions may indicate the presence of life-threatening heparin-induced thrombocytopenia. An early diagnosis is crucial to enable discontinuation of heparin if required.
Keywords: Low molecular weight heparin, UFH, bullous haemorrhagic dermatosis, hypersensitivity, idiosyncracy, dose-related reaction