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Remote Heparin-Induced Haemorrhagic Bullae Occurring in a Patient Treated for Acute Coronary Syndrome: A Rare Entity.

Bullous haemorrhagic dermatosis (BHD) is an unusual side effect of heparin. 1 In contrast to other more common side effects which usually occur at heparin injection site, BHD typically occurs at a site distant to the injection. It presents with small, haemorrhagic blisters most commonly on the extremities. 1 Diagnosis can be made clinically after thorough history and examination. However, skin biopsy will be helpful to differentiate from other blistering diseases. 1 Histological finding is intraepidermal blister filled with red blood cells. 1,2 The pathophysiology of BHD is not entirely known. Possible mechanisms include delayed type of hypersensitivity, anticoagulation overdose and heparin-platelet factor 4 (HPF4) antibodies. 1-3 Management can either be continuation of heparin under observation or discontinuation with or without anticoagulant substitution. 1 The objective of this case report is to highlight this rare side effect of heparin to avoid misdiagnosis.