H. Borman et al., PROGRESSIVE GANGRENE OF THE HAND FOLLOWING EXTRAVASATION OF ANTIBIOTICS ASSOCIATED WITH HEREDITARY RESISTANCE TO ACTIVATED PROTEIN-C, Annals of plastic surgery, 41(2), 1998, pp. 194-196
Protein C, a vitamin K-dependent potent anticoagulant, is synthesized
in the liver. Hereditary resistance to activated protein C is a condit
ion that increases the risk of thrombosis as a result of mutation in f
actor V gene (factor V Leiden). It is generally accepted to be associa
ted with venous thrombosis. We present a patient who was given antibio
tics via the dorsal hand veins. Venous thrombosis in the hand that ens
ued from the extravasation of antibiotics resulted in the formation of
arterial thrombosis that eventually lead to necrosis. Factor V gene a
nalysis showed that the patient was heterozygous for the common factor
V arginine(506) to glutamine mutation. To the best of our knowledge,
hand necrosis due to antibiotic extravasation associated with heredita
ry resistance to activated protein C has not been reported previously.