Cutaneous allergic reaction to subcutaneous vitamin K1: A case report and review of literature

Abstract

BACKGROUND

Vitamin K₁ (phytomenadione) is a fat-soluble naturally occurring vitamin that is widely used to treat certain coagulation disorders. Adverse cutaneous reactions to vitamin K₁ can occur; however, owing to its low incidence and considerable variability in presentation and morphology, its diagnosis can be easily overlooked. Managing these reactions may be challenging for patients and clinicians. Therefore, reviewing the adverse cutaneous reactions to vitamin K₁ is important.

CASE SUMMARY

Here we report the case of a 50-year-old woman with no pre-existing hepatic disease who developed a cutaneous allergic reaction to subcutaneous vitamin K₁ that presented as localized eczematous plaques at the vitamin K₁ injection site. The eruption developed within 5 d of the injection and persisted for 32 mo despite treatment with topical and intralesional steroids. Eczema was diagnosed based on the results of the pathological examination, immunohistochemical staining, and a skin biopsy. The patient was advised to take herbal medicines orally twice daily. After treatment and follow-up, the patient’s eczematous urticarial plaques improved and her condition stabilized.

CONCLUSION

Here we present the first case of a cutaneous allergic reaction to subcutaneous vitamin K₁ that was successfully treated with Chinese medicine.

Keywords: Vitamin K₁ ; Subcutaneous injection; Adverse reactions; Herbal medicine; Polyoxyethylated castor oil; Case report guidelines; Case report

Core Tip: Adverse cutaneous reactions to vitamin K₁ can occur; however, their diagnosis can easily be overlooked. Managing these reactions may be challenging for both patients and clinicians. Here we report a patient who developed a cutaneous allergic reaction to subcutaneous vitamin K₁ that was successfully treated with herbal medicine, suggesting that Chinese medicine therapy may be a feasible way to treat adverse cutaneous reactions. We confirmed our clinical findings through physical examination, a skin biopsy, and immunohistochemical staining. We also conducted a literature review of eczematous-type reactions to clarify the possible pathogenesis and provoke new thinking regarding the clinical treatment of this disease.