J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 10, Number 9, September 2019, pages 280-283

Significant Muscle Hemorrhage Associated With Low-Molecular-Weight Heparin Use in Dermatomyositis: A Case Report

Figures

Figure 1. (a) Gottron’s papules on both hands. (b) Both periorbital edema and heliotrope rash. (c) Focal wedge-shaped consolidation in right lower lobe and filling defect in the distal right lower pulmonary vein (arrow).

Figure 2. CT scan of the lower extremities after bleeding. CT scan with contrast shows bleeding into (a) iliopsoas muscle (arrow), and (b) thigh muscle (arrow). CT: computed tomography.

Table

**Table 1.** Comparison of Six Cases of Dermatomyositis Accompanied by Hemorrhagic Myositis With Heparin Use
Case	Age	Sex	Bleeding sites	Type of anticoagulant	Onset after administration of anticoagulant	Coagulability	Treatment	Outcome	Reference
M: male; F: female; UFH: unfractionated heparin; APTT: activated partial thromboplastin time.
1	80	M	Left rectus sheath, oblique, right thigh	UFH	9 days	APTT prolonged	Transfusion	Alive	[3]
2	77	F	Left iliopsoas, left iliacus, retroperitoneum	UFH, ticlopidine	4 days	APTT prolonged	Embolization	Death	[4]
3	64	F	Right psoas, right iliacus, retroperitoneum, left rectus sheath	Dalteparin	9 days	Normal	Embolization	Death	[5]
4	65	F	Both iliopsoases, thighs	UFH	4 days	APTT prolonged	Transfusion	Alive	[6]
5	60	M	Left deltoid, left trapezius	UFH	6 days	APTT prolonged	Transfusion	Death	[7]
6	43	M	Left iliopsoas, left iliacus, retroperitoneum	Enoxaparin	10 days	Normal	Transfusion	Alive	Our case