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An unusual case of warfarin-induced pinna skin necrosis

Published online by Cambridge University Press:  17 October 2008

M Martinez Del Pero ,
S Verma ,
A Espeso ,
M Griffiths  and
P Jani
M Martinez Del Pero*
Affiliation:
Department of ENT, Addenbrooke's Hospital, Cambridge, UK
S Verma
Affiliation:
Department of ENT, Addenbrooke's Hospital, Cambridge, UK
A Espeso
Affiliation:
Department of ENT, Addenbrooke's Hospital, Cambridge, UK
M Griffiths
Affiliation:
Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK
P Jani
Affiliation:
Department of ENT, Addenbrooke's Hospital, Cambridge, UK
*
Address for correspondence: Mr M Martinez Del Pero, Clinical Research Fellow, Department of Otolaryngology, University of Cambridge Addenbrooke's NHS Trust, Hills Road, Cambridge CB1 1QQ, UK. Fax: 01223 217559 E-mail: marcos@doctors.org.uk
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Abstract

Introduction:

Warfarin-induced skin necrosis is a rare but recognised complication of this drug. The condition predominantly affects the breasts, buttocks and thighs of obese, peri-menopausal women. We present the case of a patient with the condition in an unusual site, and we discuss the management challenges involved.

Case report:

An 82-year-old man presented to the ENT department with a diagnosis of pinna haematoma. There was no history of trauma or infection. The patient was taking warfarin long-term for recurrent deep vein thrombosis. Two weeks prior to admission, the patient had had a loading course of warfarin following surgery. Multiple clinical teams were involved in treatment. The only abnormal laboratory investigation was a low protein S level; biopsy showed skin necrosis.

Conclusion:

In this case, the unusual presentation created diagnostic confusion, and may have precipitated aggressive surgical debridement. However, a more conservative management strategy was used, which we would recommend in future.

Keywords

Skin NecrosisPinna NecrosisWarfarin Therapy Complication
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 6 , June 2009 , pp. 685 - 688
Copyright
Copyright © JLO (1984) Limited 2008

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