Familial type II protein C deficiency associated with warfarin‐induced skin necrosis and bilateral adrenal hemorrhage

A family is described in which venous thromboembolic disease is associated with reduced plasma protein C activity and normal levels of protein C antigen. Immunoelectrophoretic analysis of protein C antigen gave an abnormal pattern in all affected members, suggesting that the disorder is related to the presence of a structurally and functionally abnormal form of protein C. The propositus developed simultaneous warfarin‐induced skin necrosis and bilateral adrenal hemorrhage. This is the first reported instance of warfarin‐induced skin necrosis associated with a dysfunctional protein C molecule and the first reported instance of simultaneous warfarin‐induced skin necrosis and bilateral adrenal hemorrhage.