Acenocoumarol induced ecchymosis and multidermatomal haemorrhagic herpes zoster

• Author Details:   
• Samuel Jeyaraj Daniel
• Saranya Selvam
• K Desingh ^*

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A 65-year-old male presented with haemorrhagic skin lesions over the right buttock region and thighs for the past five days. He also had multiple ecchymotic patches of variable size in the body. Patient gave an history of surgery one month before the onset of haemorrhagic lesions, left iliac vein angioplasty for May Thurner syndrome. Subsequently, he was started on Acenocoumarol (Tab. Acitrom 2mg once daily). Dermatological examination revealed multiple grouped haemorrhagic vesicular skin lesions distributed along the L3,L4 and L5 dermatomes in the right side of the body. There were multiple asymmetrical ecchymotic patches over both the upper limbs and the abdomen. Investigations revealed prolonged coagulation profile. Patient was treated with standard acyclovir therapy for one week along with ascorbic acid. Subsequently, the ecchymotic patches completely disappeared and the vesicles started to resolve. Review of literature with clinical and laboratory correlation suggested Acenocoumarol to be the cause of Haemorrhagic skin lesions including those of herpes zoster in our case, so the drug was withdrawn.

Keywords: Acenocoumarol, Ecchymosis, Haemorrhagic herpes zoster, Haemorrhagic vesicles, Multidermatomal zoster, Coumarin derivatives, Oral anticoagulants, Nicoumalone, Acitrom.