A 66-year-old man presented with lingual oedema of purplish colour, with pain and swelling and was admitted to the emergency room. He was taking warfarin at a dose of 5 mg for mitral valve disease as well as a diuretic and digoxin. He had not been exposed to any trauma.

On physical examination, no haemorrhagea was observed other than that of lingual haematoma (fig 1). Laboratory examinations showed an international normalised ratio of 50.15, a haemoglobin value of 8.7 g/dl. Nasal oxygen, 5 IU fresh frosen plasma, 2 U erythrocyte suspension and 20 mg vitamin K were given to the patient. Two days later, the lingual haematoma had disappeared.

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Figure 1 Lingual haematoma caused by usual warfarin dose. Informed consent was obtained for publication of this figure.

Haemorrhageas caused by warfarin overdose usually appear in the genitourinary, gastrointestinal, retroperitoneal and intracranial areas. In the literature, 10 cases have so far been reported, including sublingual and retropharyngeal haemorrhagea. This is the first isolated lingual haematoma observed on a normal warfarin dose without overdosing, according to our knowledge, to be reported in the literature.