Warfarin-induced skin necrosis concurrent with dengue fever: a case report highlighting diagnostic and management challenges in a conflict-affected region

Warfarin-induced skin necrosis (WSN) is a rare but serious complication of anticoagulation therapy. This case report describes a 34-year-old male with mechanical heart valves on long-term warfarin therapy who developed WSN after self-medicating with a doubled warfarin dose following a two-week interruption due to limited healthcare access in a conflict-affected region. Concurrently, he was diagnosed with dengue fever, further complicating anticoagulation management due to thrombocytopenia. Prompt discontinuation of warfarin, intravenous vitamin K administration, and delayed initiation of enoxaparin after platelet recovery were key aspects of treatment. Surgical debridement of necrotic skin lesions was performed, resulting in stabilization and recovery. This case highlights the unique diagnostic and management challenges of WSN in the setting of a concurrent dengue infection, especially in resource-limited settings and conflict-affected areas. Early recognition and tailored intervention are essential to prevent severe complications and improve outcomes.