A 68-year-old man comes to the emergency department 12 hoursdue to a large, painful skin lesion. He began taking a medication 4 days ago after failed cardioversion for atrial fibrillation, but he cannot remember the name. Physical examination shows a tender bluish-black discoloration on the forearm. Temperature is 36.7 C (98 F), blood pressure is 130/82 mm Hg, and pulse is 88/min and irregularly irregular. Physical examination findings are shown in the image below. The remainder of the skin examination is normal. Which of the following is the most likely cause of this patient's skin lesion?

Question

A 68-year-old man comes to the emergency department 12 hoursdue to a large, painful skin lesion. He began taking a medication 4 days ago after failed cardioversion for atrial fibrillation, but he cannot remember the name. Physical examination shows a tender bluish-black discoloration on the forearm.  Temperature is 36.7 C (98 F), blood pressure is 130/82 mm Hg, and pulse is 88/min and irregularly irregular.  Physical examination findings are shown in the image below.  The remainder of the skin examination is normal.  Which of the following is the most likely cause of this patient's skin lesion?

Quizplus · Accepted Answer

Eductional Objective: Patients started on warfarin develop a transient hypercoagulable state due to the short half-life of protein C.  This hypercoagulability is further exaggerated by preexisting protein C deficiency and can result in thrombotic occlusion of the microvasculature with skin necrosis.

A 68-Year-Old Man Comes to the Emergency Department 12 Hoursdue