Bullous Hemorrhagic Dermatosis at Distant Sites: A Report of 2 New Cases Due to Enoxaparin Injection and a Review of the Literature

Low-molecular-weight heparin-induced skin necrosis without platelet fall: a case report in pregnancy

Background:

Skin necrosis, following subcutaneously administered low-molecular-weight heparin (LMWH) is a rare but serious complication and has not been documented during pregnancy in the literature to the best of our knowledge. Therefore, we are of the opinion that reporting this case may guide clinicians when presented with such patients.

Main observations:

A 36-year-old woman with painful skin lesions was admitted to our clinic at 36 gestational weeks’ of her first pregnancy. There was nothing remarkable in her medical history other than using prophylactic regimen of “low-molecular-weight heparin” (enoxaparine) 4000 units anti-Xa subcutaneously because of heterozygous factor V Leiden mutation. Potential reasons of the lesions were considered to be immunological reaction between heparin and dermal cells and management considered with these findings.

Conclusions:

Heparin-induced skin necrosis (HISN) is a condition that should always be borne in mind when there are nonspecific results. Enoxaparine treatment during pregnancy has a rare potential risk of causing necrosis at the injection site and it is reversible with careful intervention.