vitamin-k-1 and Scleroderma--Localized

We describe a 45-year-old white man in whom distinctive clinical and histologic features of localized scleroderma developed at sites of injection of vitamin K1 (phytonadione). A direct immunofluorescence test demonstrated prominent linear deposition of IgA along the basement membrane zone. No circulating antibasement membrane zone IgA antibodies were identified on indirect immunofluorescence testing. We believe that the unusual immunofluorescence finding in our patient is nonspecific and represents an epiphenomenon caused by cutaneous injury.

Topics: Antifibrinolytic Agents; Basement Membrane; Fluorescent Antibody Technique, Direct; Fluorescent Antibody Technique, Indirect; Humans; Hypoprothrombinemias; Immunoglobulin A; Injections, Intramuscular; Male; Middle Aged; Scleroderma, Localized; Skin; Vitamin K 1

Cutaneous reactions to vitamin K1 (phytomenadione) are uncommon. They can present as acute eczematous reactions or late reactions that resemble localized scleroderma after vitamin K1 injections. A case is reported here of a patient who developed bilateral sclerodermoid plaques in a cowboy's holster pattern, which persisted for more than 10 years after subcutaneous vitamin K1 injections. Positive intradermal test with vitamin K1 that persisted as an erythematous indurated plaque at the test site for more than 5 months confirmed marked cutaneous hypersensitivity to vitamin K1 in this patient. Serial biopsies of the erythematous plaque at the test site showed transition from spongiotic eczematous features initially to inflammatory morphoea-like histology over a 5 month period. Possible pathogenic mechanisms for phytomenadione-induced pseudoscleroderma are discussed.

Topics: Aged; Aged, 80 and over; Biopsy, Needle; Humans; Male; Scleroderma, Localized; Vitamin K 1

Vitamin K1 (phytomenadione or phytonadione) is a fat soluble vitamin used to treat certain coagulation disorders. Intra muscular injection of vitamin K1 can occasionally be complicated by different types of skin reactions: erythematous plaques, urticarial rashes or scleroderma-like lesions at the injection site. We report the case of a 52-year-old man presenting with 2 symmetrical erythematous-infiltrated scleroderma-like plaques localized on the right and left lower trunk. To correct the coagulation deficiency with hypoprothrombinemia developed as a consequence of HCV+ hepatitis, the patient was on vitamin K1 therapy, administered by i.m. injection (10 mg Vitamin K1/1 ml) once a day for 2 weeks. Three months after treatment interruption, ivory indurated morphoeiform plaques developed at the injection sites, assuming the typical appearance of a "cowboy's belt with revolver". The scleroderma-like lesions persisted 2 years after vitamin K1 withdrawal. We report this case to highlight the possibility that vitamin K1 injections can occasionally be complicated by different types of skin reactions such as sclerodermatous plaques. Due to the delay in the onset, to the variable clinical picture, to the persistence after therapy interruption, this kind of lesions can represent a tricky diagnostic challenge and in spite of different treatments can endure for years.

Topics: Diabetes Mellitus, Type 2; Erythema; Hepatitis C, Chronic; Humans; Hypoprothrombinemias; Injections, Intramuscular; Male; Middle Aged; Scleroderma, Localized; Vitamin K 1

Texier's disease or pseudosclerodermatous reaction after intramuscular injection of vitamin K1 is well known in adults although only 1 report of a case in a newborn was found in the literature. We report 6 cases.. Six infants (4 boys, 2 girls) developed "peau d'orange" skin lesions after the age of 6 months which was localized in the lower third of the medial aspect of the thigh. Initial rapid locoregional extension was followed by stabilization and then regression. In all 6 cases, histology showed lesions of the fascia and/or the deep hypoderma associated with variable mononuclear inflammatory infiltration and hyalin fibrosis. When performed, immunological studies (complement fixation, search for autoantibodies) were always negative or normal. No visceral involvement was found.. A pseudosclerodermatous lesion of the lower third of the thigh occurred in 6 infants at the site of an intramuscular injection of vitamin K1 administered at birth. The history, clinical manifestations, histology and outcome of these cases are compatible with the diagnosis of Texier's disease. We discuss the role of the solvent in the Roche vitamin K1 injection. The pathogenesis of this side effect remains unknown.. Texier's disease in infants after injection of vitamin K1 at birth is a stereotypic dermatosis. Diagnosis is based on history and clinical presentation. The causal effect of injectable vitamin K1 should be entertained whenever pseudosclerodermatous lesions are observed in a young child.

Topics: Antifibrinolytic Agents; Diagnosis, Differential; Female; Humans; Infant; Infant, Newborn; Male; Scleroderma, Localized; Thigh; Vitamin K 1

Topics: Aged; Atrophy; Buttocks; Female; Humans; Hypoprothrombinemias; Injections, Intramuscular; Scleroderma, Localized; Skin; Vitamin K 1

Topics: Buttocks; Drug Eruptions; Female; Humans; Injections, Intramuscular; Middle Aged; Scleroderma, Localized; Vitamin K 1

Two patients showed symmetrical sclerodermoid (morphea-like) skin lesions at sites of intramuscular phytonadione (vitamin K1) injections. The lesions appeared one and two years after the injections. A dense sclerosis involving the reticular dermis and subcutaneous fat was observed on histologic examination of biopsy specimens. Local adverse reactions to phytonadione are reviewed. Possible causative mechanisms for phytonadione-induced pseudoscleroderma are discussed.

Topics: Aged; Biopsy; Humans; Injections, Intramuscular; Male; Middle Aged; Scleroderma, Localized; Skin; Vitamin K 1

Topics: Aged; Female; Humans; Injections, Intramuscular; Scleroderma, Localized; Syndrome; Vitamin K 1

We treated a case of subcutaneous sclerosis after phytonadione injections (Texier's disease) that was noteworthy for two associated features: sclerosis with inflammatory infiltrate in the fascia, and blood eosinophilia. A peculiar type of cutaneous sclerosis after phytonadione injections was described in 1972. The sclerosis in that case was first confined to the buttocks, progressively extended to both thighs, and slowly resolved. In the 38 reported cases, neither sclerosis of the fascia nor blood eosinophilia was observed.

Topics: Drug Eruptions; Eosinophilia; Fasciitis; Humans; Male; Middle Aged; Scleroderma, Localized; Vitamin K 1

Topics: Buttocks; Child; Child, Preschool; Humans; Injections, Intramuscular; Male; Scleroderma, Localized; Vitamin K 1

Topics: Buttocks; Erythema; Female; Humans; Injections, Intramuscular; Liver Cirrhosis; Male; Microscopy, Electron; Middle Aged; Scleroderma, Localized; Skin; Vitamin K 1

Topics: Aged; Biopsy; Buttocks; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Scleroderma, Localized; Vitamin K 1

Topics: Adult; Humans; Lumbosacral Region; Male; Scleroderma, Localized; Vitamin K 1

Topics: Collagen; Drug Combinations; Erythema; Humans; Injections, Intramuscular; Ketoglutaric Acids; Liver Extracts; Lumbosacral Region; Ornithine; Scleroderma, Localized; Vitamin K 1