Abstract
A 71-year-old woman had been on hemodialysis with heparin for end-stage renal failure due to chronic glomerulonephritis since 1996. She was found to have necrosis of her left toe on the day of hemodialysis in May 2013. The platelet count was 49,000/μL (the prior month' s count, 189,000/μL) and the CK value was 1,074 U/L. Contrast-enhanced CT showed the maintenance of blood flow up to the popliteal artery. The posterior tibial and dorsalis pedis arteries were identified on Doppler ultrasonography. We therefore considered the occlusion to be localized at the level of the toe. A test for heparin-induced thrombocytopenia (HIT) antibody was strongly positive. On the basis of these findings, typeⅡ HIT complicated by acute arterial occlusion of the lower extremity was diagnosed. After admission, heparin was discontinued, and the patient was treated with continuous infusion of argatroban. On hospital day 4, she underwent amputation of the left lower extremity. Although her platelet count gradually increased, HIT antibody remained positive during the course of treatment. The patient underwent regular hemodialysis with the administration of argatroban. The patient was discharged on hospital day 70. The incidence of typeⅡ HIT in the introduction phase of hemodialysis is reportedly 3-4%. However, since typeⅡ HIT is a rare occurrence in the maintenance phase, we report this case with a review of the relevant literature.
