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Acta Medica Colombiana

Print version ISSN 0120-2448

Acta Med Colomb vol.45 no.4 Bogotá Oct./Dec. 2020  Epub June 12, 2021 

Images in internal medicine

Bullous hemorrhagic dermatosis at distant sites

Marío Andrés Hernández-Sómersona  * 

Jaime Ortiz-Arroyob 

a Especialista en Medicina Interna, Servicio de Clínicas Médicas Hospital Universitario Mayor - MEDERI, Docente Facultad de Ciencias de la Salud Universidad del Rosario. Bogotá, D.C. (Colombia).

b Servicio de Clínicas Médicas, Hospital Universitario Mayor - MEDERI. Bogotá, D.C. (Colombia).

A 72-year-old man was hospitalized for acute heart failure. He had a history of arterial hypertension being treated with enalapril and hydrochlorothiazide. Thromboprophylaxis was begun at admission with 40 mg of subcutaneous enoxaparin daily, in the abdomen. Three days later, tense, blood-filled bullous skin lesions with a 5-15 mm diameter appeared. The lesions were on the right arm (Figure 1) and the left foot (Fig ure 2); they had an erythematous halo and were not painful. Clotting, C-reactive protein, ESR and complete blood count were normal. A skin biopsy was performed, which showed a subepidermal lesion with hemorrhagic material in the papillary and reticular dermis with scant neutrophils and no vasculitis or thrombosis. These findings confirm the diagnosis of bullous hemorrhagic dermatosis at distant sites related to enoxaparin. This is an uncommon and self-resolving adverse effect of heparins, unrelated to the dose and at sites distant from their application. This patient was treated by discontinu ing the medication, and the lesions resolved seven days later with no recurrence after three months of follow-up.

Figure 1 Lesions on the right arm. 

Figure 2 Lesions on the left foot. 

Received: November 26, 2019; Accepted: August 12, 2020

* Correspondencia: Mario Andrés Hernández-Sómerson. Bogotá, D.C. (Colombia). E-mail:

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License