(BMJ)—A 74-yo man w/ afib x 6 wks treated w/ warfarin presented w/ pain and purple discoloration of toes on left foot x 2 wks. Exam: pedal pulses intact, no neuro deficits. What is the dx?
Cryoglobulinemia
Warfarin-related purple toe syndrome
Achenbach syndrome
Pheochromocytoma
Raynaud phenomenon
You are correct. The purple discoloration disappeared when the warfarin was stopped. Purple toe syndrome is a rare complication of warfarin therapy thought to be caused by cholesterol microemboli. Typically, it begins within 3 to 8 wks of starting tx.