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[Clinical Picture] Bleeding interaction between fluconazole and warfarin

A 71-year-old woman with paroxysmal atrial fibrillation being treated with warfarin 3·75 mg/day presented at our hospital with a 5-day history of increasing swelling in her neck, sialorrhoea, and difficulty swallowing. 1 week earlier, she had been started on fluconazole 200 mg once a day because of oral candidiasis. She was afebrile. Physical examination showed a large, soft, dark-red swelling on the floor of her mouth: her tongue was displaced superiorly. She had a sublingual haematoma (figure).