Korean J Med.
1999 Feb;56(2):225-228.
A Case Report of Purple Toe Syndrome Associated with Acute Renal Failure during Warfarin Therapy
- Affiliations
-
- 1Department of Internal Medicine, Yonsei University College of Medicine.
- 2The Institute of Kidney Disease, Yonsei University, Seoul, Korea.
Abstract
-
"Purple toe" syndrome is an extremely rare complication of warfarin therapy. The occurrence
of purple toe syndrome is characterized by a sudden appearance of purplish discoloration of
toes and the sides of feet. The skin lesions usually develop 3-8 weeks after beginning
anticoagulation. The pathogenesis was not clearly defined but the presence of atherosclerosis
in most of patients led to suggest that the mechanism was related to cholesterol emboli from
the atherosclerotic plaques and warfarin- induced bleeding into the plaques. These microemboli
are commonly associated with irreversible organ dysfunction such as renal failure, distal
gangrene, pancreatitis, and multifocal myocardial necrosis. Therefore purple toe syndrome may
be considered as a sentinel of cholesterol crystal embolism. Once established, anticoagulation
and thrombolysis are contraindicated. Necrosis and gangrenous changes may result in loss of
limb and occasional mortality has been reported. We report a case of purple toe syndrome
associated with acute renal failure after warfarin therapy with a review of literatures.