Heparin-Induced Hemorrhagic Bullous Dermatosis: A Rare Complication of Unfractionated Heparin

TL;DR

An 82-year-old woman developed a rare skin condition after heparin treatment, highlighting the need to recognize uncommon side effects of this medication.

Contribution

This case report documents a rare adverse reaction to unfractionated heparin, contributing to clinical awareness of heparin-induced hemorrhagic bullous dermatosis.

Findings

The patient developed hemorrhagic bullae and purpura after six days of heparin therapy.

Thrombocytopenia was observed, supporting the diagnosis of heparin-induced dermatosis.

Continued heparin with supportive care led to significant improvement in the patient's condition.

Abstract

We present a case of an 82-year-old female with a significant medical history of hypertension and Alzheimer’s disease who developed heparin-induced hemorrhagic bullous dermatosis during treatment for a subsegmental pulmonary embolism. The patient was admitted with lower extremity edema and cyanosis, diagnosed with a subsegmental pulmonary embolism, and started on therapeutic doses of unfractionated heparin. On the sixth day of heparin therapy, she developed abdominal bloating and a diffuse exanthematous rash, which progressed to hemorrhagic bullae on the plantar and dorsal aspects of her feet, alongside extensive purpura on her legs. Laboratory findings revealed thrombocytopenia. Multidisciplinary consultations confirmed the diagnosis of heparin-induced hemorrhagic bullous dermatosis. Management included continuing unfractionated heparin with close monitoring, supportive topical treatments, and a subsequent transition to rivaroxaban. The patient’s condition improved significantly, and she was discharged in stable condition. This case highlights the importance of recognizing rare adverse reactions to heparin and raises the question of preventive measures or risk factors related to this manifestation.

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