Eczema-like plaques secondary to enoxaparin misdiagnosed as DRESS-syndrome

Low-molecular-weight heparins may cause adverse skin reactions, especially eczematous eruptions. A 60-year-old woman with a history of mitral valve replacement and frontal hemorrhagic stroke, who had been treated with carbamazepine and enoxaparin for 2 months, consulted our department for a sudden onset of generalized pruritic rash. There was facial edema, cheilitis, and a rash of eczematous lesions electively localized to the site of enoxaparin injections. Blood analysis showed eosinophilia= 2500 e/mm3, gamma GT = 526 and lipasemia= 126. Initially we suspected the diagnosis of carbamazepine induced DRESS syndrome. Then the final diagnosis was generalized eczema on heparin in view of the exclusive localization of the lesions at the sites of enoxaparin injections, the rapid resolution of the eruption and the result of biopsy and allergological investigation. Dermatologic effects of heparins commonly used in medical and surgical practice are numerous, and clinical pictures can be misleading, as in our case.