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.

Keyword

Purple toe syndrome; acute renal failure; warfarin; cholesterol embolism

MeSH Terms

Acute Kidney Injury*
Atherosclerosis
Cholesterol
Embolism
Embolism, Cholesterol
Extremities
Foot
Gangrene
Hemorrhage
Humans
Mortality
Necrosis
Pancreatitis
Plaque, Atherosclerotic
Renal Insufficiency
Skin
Toes*
Warfarin*
Cholesterol
Warfarin
Full Text Links
  • KJM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2025 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr