PT  - JOURNAL ARTICLE
AU  - Maria Chicco
AU  - George Filobbos
AU  - Nicholas Francis
AU  - Paul Ziprin
TI  - A mysterious postoperative rash
AID  - 10.1136/bcr-2017-223999
DP  - 2018 May 15
TA  - BMJ Case Reports
PG  - bcr-2017-223999
VI  - 2018
4099  - http://casereports.bmj.com/content/2018/bcr-2017-223999.short
4100  - http://casereports.bmj.com/content/2018/bcr-2017-223999.full
AB  - 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.