Case report: Late onset warfarin-induced skin necrosis

Warfarin induced skin necrosis (WISN) represents a rare complication of warfarin therapy that is associated with high incidence of morbidity and mortality. It usually presents in susceptible patients within 10 days of initiation of therapy.  The study report a case of 24 years old gentleman who is known to have a unique rare inborn error of metabolism (primary hyperoxaluria), and was diagnosed with late onset WISN after being on warfarin for 28 months for recurrent pulmonary embolisms. The skin lesions in the study patient were not associated with underlying protein C or S deficiency.   Key words: Warfarin induced skin necrosis, primary hyperoxaluria (PH), calciphylaxis, end stage renal disease (ESRD).