21 November 2002
Acute digital gangrene in a long-term dialysis patient - a diagnostic challenge.
Giorgina Barbara Piccoli, Marco Quaglia, Pietro Quaglino, Manuel Burdese, Francesca Bermond, Elisabetta Mezza, Alberto Jeantet, Giuseppe Paolo SegoloniMed Sci Monit 2002; 8(11): CS83-89 :: ID: 4830
Abstract
BACKGROUND: Vascular complications are frequent in long-term dialysis patients. The differential diagnosis is complex and includes immunological derangement (underlying disease, uremia), vasculopathic-atheroembolic diseases, calciphylaxis, infections, neoplasm, coagulation disorders, and adverse drug effects. CASE REPORT: We report on a 50-year-old male patient with a long follow-up on renal replacement therapy (20 years), currently on daily hemodialysis. The patient's history of kidney transplantation was complicated by seven acute rejection episodes and by Kaposi sarcoma; comorbidity included HLA-B27 positive ankylosing spondylitis, diffuse vascular disease, recurrent atrial fibrillation, chronic hypotension, HCV positivity. Ten days after the start of warfarin for an atrial fibrillation episode, the patient developed digital necrotising ulcerations, rapidly evolving into partial symmetric digital gangrene at distal phalanxes. The timing and evolution of the lesions and the finding of protein S deficiency were the clues for diagnosing warfarin-induced skin necrosis (WISN); the drug was discontinued and therapy with low-molecular weight heparin, plasma and prostacyclin achieved slow resolution of lesions. CONCLUSIONS: According to a combined MEDLINE and EMBASE search, this is the first report of WISN in a hemodialysis patient: underlining the clinical relevance of this uncommon problem, this case exemplifies the difficult differential diagnosis of acute vascular skin lesions in dialysis patients.
Keywords: Dialysis - adverse effects, Fingers - pathology, Gangrene - diagnosis, HLA-B27 Antigen - metabolism, Renal Replacement Therapy - adverse effects, Spondylitis, Ankylosing - complications
Editorial
01 March 2025 : Editorial
Editorial: The World Health Organization (WHO) Updated List of Emerging and Potentially Pandemic Pathogens Includes Yersinia pestis as Plague Vaccines Await Clinical TrialsDOI: 10.12659/MSM.948672
Med Sci Monit 2025; 31:e948672
In Press
Clinical Research
Comparative Analysis of Laser Therapies for Striae Distensae: Fractional CO₂ vs Combined Q-Switch Nd:YAGMed Sci Monit In Press; DOI: 10.12659/MSM.947464
Database Analysis
Utility of Central Venous Oxygen Saturation Gradient in Predicting Mortality in Dialysis with Catheter AccessMed Sci Monit In Press; DOI: 10.12659/MSM.947298
Clinical Research
Intraoperative Renal Near-Infrared Spectroscopy Monitoring as a Predictor of Renal Outcomes in Cardiac SurgeryMed Sci Monit In Press; DOI: 10.12659/MSM.947462
Clinical Research
Impact of Cholecalciferol Supplementation on Radiotherapy Outcomes in Advanced Cervical CancerMed Sci Monit In Press; DOI: 10.12659/MSM.945964
Most Viewed Current Articles
17 Jan 2024 : Review article 7,110,480
Vaccination Guidelines for Pregnant Women: Addressing COVID-19 and the Omicron VariantDOI :10.12659/MSM.942799
Med Sci Monit 2024; 30:e942799
16 May 2023 : Clinical Research 702,343
Electrophysiological Testing for an Auditory Processing Disorder and Reading Performance in 54 School Stude...DOI :10.12659/MSM.940387
Med Sci Monit 2023; 29:e940387
01 Mar 2024 : Editorial 27,671
Editorial: First Regulatory Approvals for CRISPR-Cas9 Therapeutic Gene Editing for Sickle Cell Disease and ...DOI :10.12659/MSM.944204
Med Sci Monit 2024; 30:e944204
28 Jan 2024 : Review article 21,887
A Review of IgA Vasculitis (Henoch-Schönlein Purpura) Past, Present, and FutureDOI :10.12659/MSM.943912
Med Sci Monit 2024; 30:e943912