Progressive gangrene of the hand following extravasation of antibiotics associated with hereditary resistance to activated protein C.

Protein C, a vitamin K-dependent potent anticoagulant, is synthesized in the liver. Hereditary resistance to activated protein C is a condition that increases the risk of thrombosis as a result of mutation in factor V gene (factor V Leiden). It is generally accepted to be associated with venous thrombosis. We present a patient who was given antibiotics via the dorsal hand veins. Venous thrombosis in the hand that ensued from the extravasation of antibiotics resulted in the formation of arterial thrombosis that eventually lead to necrosis. Factor V gene analysis showed that the patient was heterozygous for the common factor V arginine506 to glutamine mutation. To the best of our knowledge, hand necrosis due to antibiotic extravasation associated with hereditary resistance to activated protein C has not been reported previously.