BMJ Case Reports 2018; doi:10.1136/bcr-2017-223999
  • Unexpected outcome (positive or negative) including adverse drug reactions

A mysterious postoperative rash

  1. Paul Ziprin1
  1. 1Department of General Surgery, Imperial College Healthcare NHS Trust, London, UK
  2. 2Department of Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
  3. 3Department of Histopathology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Maria Chicco, maria.chicco{at}
  • Accepted 27 April 2018
  • Published 15 May 2018


This case report describes the development of a rash in a patient admitted with large bowel obstruction secondary to carcinoma of the sigmoid colon. The patient underwent a Hartmann’s procedure and right hemicolectomy for a metastatic deposit at the terminal ileum. On postoperative day 3, the patient developed a bullous haemorrhagic rash on the thighs, flanks and abdomen, associated with a sharp drop in platelet count. Suspicion of heparin-induced skin necrosis was raised, and prophylactic enoxaparin was switched to fondaparinux. Skin biopsy results later confirmed the diagnosis. Clinical suspicion of heparin-induced skin necrosis is essential and should prompt a switch between prophylactic agents, in order to prevent potentiation of this life-threatening side effect.


  • Contributors All authors were involved in the conception and design of the case report. MC wrote the manuscript and GF, NF and PZ revised it critically for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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