Bilateral Lower Extremity Thrombosis in a Patient With Protein S Deficiency

Penile Necrosis due to Priapism Developed After Circumcision in a Patient with Protein S Deficiency

“…Because thrombolytic therapy was not initiated within the first few hours after the development of thrombosis in the first medical center, there was no rational for us to start it after development of end‐stage lesions with well‐demarcated necrotic margins in this patient. Based on our previous experience [4] and on other literature reports [14], in surgical management of tissue necrosis due to protein S deficiency, conservative debridement, and skin grafting, if necessary, should be initially attempted before performing more radical approaches. Therefore, although the penis and the surrounding skin of the pubis of the patient initially looked necrotic at the time of admission, conservative debridement and close follow‐up of the progress of the lesion were preferred to preserve as much tissue as possible, as this region of the body is composed of specialized tissue.…”

“…In general, hypercoagulable states are associated with increased risk of surgical complications. Protein S deficiency in such a state in which beside recurrent venous thrombotic events, catastrophic neonatal purpura fulminans, and arterial thrombotic events associated skin necrosis have been reported [2–4]. Protein S acts as a cofactor for protein C, which is a vitamin K‐dependent protein, like protein S, with serine proteinase action.…”