Sepsis Causing Acquired Protein C and Protein S Deficiency.

Warfarin Induced Skin Necrosis is a well-known and dreaded complication in patients who is being started on warfarin without adequate bridging with other anticoagulants. The mechanism is thought to be due to protein C deficiency acquired after initial exposure to warfarin. We present a rather unusual cause of protein C deficiency due to sepsis resulting in warfarin induced skin necrosis. 43 year old lady who has been on chronic warfarin therapy secondary to anti phospholipid syndrome was admitted to the hospital for acute ischemic cerebellar stroke. Warfarin was held due to acute thrombocytopenia. She was discharged after restarting the warfarin. She presented back with septic shock due to pneumonia. She was found to have multiple necrotic areas consistent with skin necrosis. Unfortunately, patient died due to multi organ failure despite goal directed therapy. This case demonstrates the importance of recognizing the sepsis as an acquired cause of protein C deficiency.

Renal abnormalities as incidental findings on myocardial single photon emission computed tomography perfusion imaging.

Incidental noncardiac abnormalities are frequent in myocardial perfusion imaging studies. It is important for interpreting physicians to be aware of the spectrum of abnormalities that can be detected from these studies. This report describes four cases with polycystic kidney disease with or without liver involvement and one case with polycystic liver disease with corroborative radiological studies.