我们介绍了一例82岁女性,有高血压和阿尔茨海默病的重要病史,在治疗亚段肺栓塞期间发生肝素诱导的出血性大疱性皮肤病。患者因下肢水肿和紫癜入院,诊断为亚段肺栓塞,开始服用治疗剂量的普通肝素。在肝素治疗的第六天,她出现了腹胀和弥漫性皮疹,在她的足底和背侧进展为出血性大疱,还有她腿上的大面积紫癜.实验室发现血小板减少症。多学科咨询证实了肝素诱导的出血性大疱性皮肤病的诊断。管理包括继续进行普通肝素和密切监测,支持性局部治疗,随后过渡到利伐沙班。病人的病情明显改善,她已出院,情况稳定。此案例强调了认识到肝素罕见不良反应的重要性,并提出了与此表现相关的预防措施或危险因素的问题。
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.