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Correspondence |

Remote Hemorrhagic Bullae Occurring in a Patient Treated With Subcutaneous Heparin

Urvi Pajvani Gonzales, MD; Glynis A. Scott, MD; Alice J. Briones, MD; Alice P. Pentland, MD
Arch Dermatol. 2009;145(5):604-605. doi:10.1001/archdermatol.2009.70.
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Hemorrhagic bullae often have underlying infectious causes. However, recent reports have suggested that they may also occur at sites distant from subcutaneous heparin injections,1,2 which have been linked to a variety of other skin manifestations including urticaria, erythema, calcinosis cutis, skin necrosis often secondary to vasculitis, and heparin-induced thrombocytopenia.3,4

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Figure 1.

Figure 1. Clinical (A) and close-up (B) views of multiple hemorrhagic vesicles and bullae occurring on the anterolateral surface of the lower extremity.

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Figure 2.

Figure 2. Skin biopsy specimens reveal characteristic features of bullous hemorrhagic dermatosis. A, Subcorneal collection of red blood cells within an intact vesicle (hematoxylin-eosin, original magnification ×10). B, Neutrophils and eosinophils within the dermis without evidence of vasculitis (hematoxylin-eosin, original magnification ×40).

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