Asia Pac Allergy.  2017 Apr;7(2):97-101. 10.5415/apallergy.2017.7.2.97.

Bullous hemorrhagic dermatosis due to enoxaparin use in a bullous pemphigoid patient

• Shim JS
• Chung SJ
• Kim BK
• Kim SH
• Lee KS
• Yoon YE
• Chang YS

• KMID: 2396931
• DOI: http://doi.org/10.5415/apallergy.2017.7.2.97

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.

Keyword

Hypersensitivity; Bullous dermatoses; Enoxaparin; Heparin, low-molecular-weight

MeSH Terms

Aortic Valve
Drug-Induced Liver Injury
Eczema
Enoxaparin*
Erythema
Hemorrhage
Heparin
Heparin, Low-Molecular-Weight
Humans
Hypersensitivity
Korea
Osteoporosis
Pemphigoid, Bullous*
Prostheses and Implants
Skin
Skin Diseases*
Skin Diseases, Vesiculobullous
Thrombocytopenia
Thrombosis
Transcutaneous Electric Nerve Stimulation
Urticaria
Enoxaparin
Heparin
Heparin, Low-Molecular-Weight

Figure

• 

  Fig. 1 Bullous hemorrhagic lesions. (A) Tense, hemorrhagic bulla on the right forearm. (B) Ruptured hemorrhagic bulla on the right forearm. (C) Regressed skin lesion at 4 weeks after the development.

• 

  Fig. 2 Representative figures of histopathological examination. (A) Intradermal vesicle formation with filled red blood cells (×4). (B) Mildly perivascular lymphocytic and a few eosinophilic infiltration in periphery of vesicle. No evidences of vasculitis or intravascular thrombus (×20). (C) C3 deposition of dermo-epidemal junction in immunofluorescence (×10).

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