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Choudhury A, Thokchom N, Jain V, Bairwa M. Bullous Hemorrhagic Dermatosis: A Rare Benign Cutaneous Complication of Low-Molecular-Weight Heparin. Cureus 2022; 14:e31173. [DOI: 10.7759/cureus.31173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2022] [Indexed: 11/09/2022] Open
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Al‐Mashdali AF, Yassin MA. Enoxaparin-induced bullous hemorrhagic dermatosis at a distant location from the injection site. Clin Case Rep 2021; 9:e05014. [PMID: 34745623 PMCID: PMC8552310 DOI: 10.1002/ccr3.5014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/05/2022] Open
Abstract
Heparin-induced bullous hemorrhagic dermatosis is a benign and self-limited condition. However, it might cause significant patient frustration. Clinicians should be aware of this rare adverse reaction.
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Affiliation(s)
| | - Mohamed A. Yassin
- National Center for Cancer Care and ResearchDepartment of Oncology, Hematology and BMT SectionHamad Medical CorporationDohaQatar
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Russo A, Curtis S, Balbuena-Merle R, Wadia R, Wong E, Chao HH. Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature. Exp Hematol Oncol 2018; 7:15. [PMID: 29989046 PMCID: PMC6035443 DOI: 10.1186/s40164-018-0108-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022] Open
Abstract
Bullous hemorrhagic dermatosis (BHD) is a systemic side-effect of low molecular weight heparin, characterized by multiple intra-epidermal hemorrhages distant from the site of injection. There have been several small case series and literature reviews on BHD, but none have captured a complete set of reported patients. We sought to describe a case of BHD with late diagnosis and completely summarize the existing English and Spanish literature with searches of Pubmed, Scopus, Ovid Embase and Ovid Medline. After narrowing to 33 relevant reports, we describe 90 reported cases worldwide from 2004 to 2017, in addition to a new case from our institution as a means of comparison. We found that BHD was common in elderly men (mean age 72 ± 12; male:female, 1.9:1) and typically occurred within 7 days of administration of anticoagulation (median 7 days ± 6.4) usually with enoxaparin use (66% of cases). Lesions occurred primarily on the extremities only (67.9% of cases). Coagulation testing was most often normal before administration, and the majority of patients had coagulation testing in therapeutic range during treatment. Most practitioners stopped anticoagulation if continued therapeutic intervention was no longer required (57% of cases), or changed therapy to another anticoagulation if continued treatment was required (14.3% of cases). Therapy was continued outright in 23% of patients. The lesions usually resolved within 2 weeks (mean days, 13.0 ± 7.4). There was no difference in time to resolution between patients who continued the culprit anticoagulant or changed to a different anticoagulant, and those who discontinued anticoagulation altogether (13.9 days vs. 12.1, p = 0.49). Four deaths have been reported in this clinical context, two specified as intracranial hemorrhage. These deaths were unrelated to the occurrence of BHD. Continuation of low-molecular weight heparins appeared to be safe in patients with BHD.
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Affiliation(s)
- Armand Russo
- Department of Internal Medicine, Yale School of Medicine and Yale Comprehensive Cancer Center, New Haven, CT 06511 USA
| | - Susanna Curtis
- Department of Internal Medicine, Yale School of Medicine and Yale Comprehensive Cancer Center, New Haven, CT 06511 USA
| | - Raisa Balbuena-Merle
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT 06511 USA
| | - Roxanne Wadia
- Department of Internal Medicine, Yale School of Medicine and Yale Comprehensive Cancer Center, New Haven, CT 06511 USA
- VA Connecticut Healthcare System, Cancer Center, 950 Campbell Avenue, Mailcode 111D, West Haven, CT 06516 USA
| | - Ellice Wong
- Department of Internal Medicine, Yale School of Medicine and Yale Comprehensive Cancer Center, New Haven, CT 06511 USA
- VA Connecticut Healthcare System, Cancer Center, 950 Campbell Avenue, Mailcode 111D, West Haven, CT 06516 USA
| | - Herta H. Chao
- Department of Internal Medicine, Yale School of Medicine and Yale Comprehensive Cancer Center, New Haven, CT 06511 USA
- VA Connecticut Healthcare System, Cancer Center, 950 Campbell Avenue, Mailcode 111D, West Haven, CT 06516 USA
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Shim JS, Chung SJ, Kim BK, Kim SH, Lee KS, Yoon YE, Chang YS. Bullous hemorrhagic dermatosis due to enoxaparin use in a bullous pemphigoid patient. Asia Pac Allergy 2017; 7:97-101. [PMID: 28487841 PMCID: PMC5410417 DOI: 10.5415/apallergy.2017.7.2.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/25/2017] [Indexed: 12/04/2022] Open
Abstract
Adverse reactions of subcutaneous low molecular weight heparin or unfractionated heparin could be complications by bleeding, heparin-induced thrombocytopenia, drug-induced liver injury, osteoporosis, and cutaneous reactions. Heparin-induced skin lesions vary from allergic reactions like erythema, urticaria, eczema to intradermal microvascular thrombosis associated with heparin-induced thrombocytopenia. There is a rare cutaneous complication, called bullous hemorrhagic dermatosis. We experienced this rare case of the cutaneous complication caused by enoxaparin. Several tense bullous hemorrhagic lesions occurred after 3 days of enoxaparin in a known bullous pemphigoid patient who had aortic valve replacement surgery with a mechanical prosthesis. The bullous hemorrhagic lesions were regressed after the discontinuation of enoxaparin but recurred after re-administration. The lesions were controlled by the administration of systemic corticosteroid and alternative anticoagulant. To date, less than 20 cases have been reported worldwide. This is the first case of bullous hemorrhagic dermatosis induced by enoxaparin, a low-molecular-weight heparin in Korea. This is also the first case of bullous hemorrhagic dermatosis in a known bullous pemphigoid patient.
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Affiliation(s)
- Ji-Su Shim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Soo Jie Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Byung-Keun Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Kyu Sang Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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Abstract
Bullous hemorrhagic dermatosis induced by enoxaparin is a rare, self-limiting, cutaneous adverse reaction causing no complications. In this report, we present a case where bullous hemorrhagic dermatosis developed at a location distant from the site of injection after using enoxaparin for 5 days for pulmonary venous thrombosis.
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Affiliation(s)
- Isa An
- Department of Dermatology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Mehmet Harman
- Department of Dermatology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Ibrahim Ibiloglu
- Department of Pathology, Dicle University Medical Faculty, Diyarbakır, Turkey
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Castellanos-González M, Velasco-Rodríguez D, Mancebo Plaza AB. Dermatosis ampollosa a distancia en pacientes tratados con heparina. Med Clin (Barc) 2016; 146:402-7. [DOI: 10.1016/j.medcli.2015.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
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