A suspicious case of cefmetazole‐induced hypoprothrombinemia

Kodama, Nobuhiro; Matsumoto, Shuichi; Matsubayashi, Sunao

doi:10.1002/jgf2.18

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…Ten cases of CMZ-induced hypoprothrombinemia are accessible on MEDLINE, and they have been summarized in Table 2 [ 4 , 8 , 9 , 13 , 18 – 20 ]. In these 10 cases, the average patient age was 74.7 (range: 57–93) years and the maximum PT and INR were 87.1 s [ 18 ] and 8.3 [ 19 ], respectively.…”

Section: Discussionmentioning

confidence: 99%

Hypoprothrombinemia During Cefmetazole Treatment: A Case Report

et al. 2022

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Patient: Female, 76-year-old Final Diagnosis: Drug induced hypoprothrombinemia Symptoms: Abdominal pain • fever • loss of appetite Medication: — Clinical Procedure: Blood tests • CT scan Specialty: Infectious Diseases Objective: Unusual clinical course Background: Cefmetazole (CMZ), containing an N -methyl-tetrazole-thiol (NMTT) side chain, is a therapeutic option for diverticulitis in Japan. Cephems containing an NMTT, a methyl-thiadiazol, and a thiadiazolethiol side chain are known to induce coagulation disorders. Case Report: A 76-year-old woman developed hypoprothrombinemia after receiving oral levofloxacin (LVFX) 250 mg q24h for 2 days followed by intravenous CMZ 2 g q8h for sigmoid diverticulitis. On day 5 of CMZ administration (after 12 doses in total), black stool was observed. On the following day (after 14 doses), prothrombin time (PT) prolongation was noted; PT and international normalized ratio (INR) were 37.1 s and 2.47, respectively. We diagnosed the patient with hypoprothrombinemia because of vitamin K deficiency caused by markedly elevated protein levels induced by vitamin K absence or antagonist-II on day 6 of CMZ administration. Intravenous vitamin K administration and CMZ cessation rapidly restored PT and led to the disappearance of black stool. Conclusions: The causes of vitamin K deficiency were considered to be an impaired vitamin K cycle due to CMZ and decreased vitamin K intake because of malnutrition. These findings are consistent with CMZ’s reported adverse effects. Decreased vitamin K production due to alterations in the gut bacterial flora by LVFX and CMZ was also postulated as a cause. If a bleeding tendency is noted during diverticulitis treatment with NMTT-containing cephems, switching to intravenous quinolones or carbapenems is recommended. It remains unclear how this reaction can be avoided; however, prudent monitoring of bleeding signs and PT-INR is recommended.

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Section: Discussionmentioning

confidence: 99%

Hypoprothrombinemia During Cefmetazole Treatment: A Case Report

et al. 2022

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“…Several cases of hemorrhage caused by cefoperazone (CPZ) after 5 to 11 days of use have been reported previously [7–12]. Cephalosporins containing side chains of N-methylthiotetrazole (latamoxef, cefmenoxime, cefoperazone, cefotetan, cefamandole, cefametazole) or methyl-thiadiazole (cefazolin) have been reported to be inhibitors of hepatic vitamin K epoxide reductase, leading to a lower nutritional-vitamin K status predisposes to hypothrombinemia, whereas two cephalosporins without a heterocyclic side chain (cefotaxime and cefoxitin) are not [5, 13, 14]. Cefodizime used in this case did not affect hemostasis [15].…”

Section: Discussionmentioning

confidence: 99%

Neglected Vitamin K Deficiency Causing Coagulation Dysfunction in an Older Patient with Pneumonia: A Case Report

Wu,

Wang,

Zhao

2023

Komp Nutr Diet

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<b>Background:</b> The development of coagulation disorders can be dangerous and fatal in the older people, especially those with multiple medical conditions. Vitamin K-dependent coagulation disorders are easily overlooked when anticoagulant drugs are not used and the patient shows no signs of bleeding. <b>Case presentation:</b> We report a case of a 71-year-old male suffering from pulmonary infection with severe coagulation disorder without bleeding symptoms. He also had a history of Parkinson’s disease, Alzheimer’s disease and cardiac insufficiency. Coagulation tests were normal at the time of admission, prothrombin time (PT) is 13.9 (normal, 9.5–13.1) seconds and the activated partial thromboplastin time (APTT) is 30.2 (normal, 25.1–36.5) seconds. But it turned severely abnormal after 20 days (PT: 136.1 s, APTT: 54.8 s). However, no anticoagulants such as warfarin was used and no bleeding symptoms were observed. Subsequent mixing studies with normal plasma showed a decrease in prothrombin times. Vitamin K deficiency was thought to be the cause of coagulation disorders considering long-term antibiotic therapy, especially cephalosporins, inadequate diet and abnormal liver function. After supplementation with 20 mg of vitamin K, coagulation dysfunction was rescued the next day and serious consequences were effectively prevented.

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“…Several cases of hemorrhage caused by cefoperazone (CPZ) after 5 to 11 days of use have been reported previously [7][8][9][10][11][12]. Cephalosporins containing side chains of N-methylthiotetrazole (latamoxef, cefmenoxime, cefoperazone, cefotetan, cefamandole, cefametazole) or methyl-thiadiazole (cefazolin) have been reported to be inhibitors of hepatic vitamin K epoxide reductase, leading to a lower nutritional-vitamin K status predisposes to hypothrombinemia, whereas two cephalosporins without a heterocyclic side chain (cefotaxime and cefoxitin) are not [5,13,14]. Cefodizime used in this case did not affect hemostasis [15].…”

Section: Discussionmentioning

confidence: 99%

Neglected vitamin K deficiency causing coagulation dysfunction in an older patient with pneumonia: a case report

Wang

Zhao

2022

BMC Geriatr

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Background The development of coagulation disorders can be dangerous and fatal in the older people, especially those with multiple medical conditions. Vitamin K-dependent coagulation disorders are easily overlooked when anticoagulant drugs are not used and the patient shows no signs of bleeding. Case presentation We report a case of a 71-year-old male suffering from pulmonary infection with severe coagulation disorder without bleeding symptoms. He also had a history of Parkinson’s disease, Alzheimer’s disease and cardiac insufficiency. Coagulation tests were normal at the time of admission, prothrombin time (PT) is 13.9 (normal, 9.5–13.1) seconds and the activated partial thromboplastin time (APTT) is 30.2 (normal, 25.1–36.5) seconds. But it turned severely abnormal after 20 days (PT: 136.1 s, APTT: 54.8 s). However, no anticoagulants such as warfarin was used and no bleeding symptoms were observed. Subsequent mixing studies with normal plasma showed a decrease in prothrombin times. Vitamin K deficiency was thought to be the cause of coagulation disorders considering long-term antibiotic therapy, especially cephalosporins, inadequate diet and abnormal liver function. After supplementation with 20 mg of vitamin K, coagulation dysfunction was rescued the next day and serious consequences were effectively prevented. Conclusions Overall, timely vitamin K supplementation with antimicrobials that affect vitamin K metabolism requires clinician attention, especially in older patients who are multimorbid, frail or nutritionally compromised, and are admitted to hospital because of an infection that needs antimicrobial therapy are at risk of clotting disorders due to abnormal vitamin K metabolism secondary to altered gut flora, which can exacerbate existing nutritional deficiencies.

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A suspicious case of cefmetazole‐induced hypoprothrombinemia

Cited by 5 publications

References 7 publications

Hypoprothrombinemia During Cefmetazole Treatment: A Case Report

Hypoprothrombinemia During Cefmetazole Treatment: A Case Report

Neglected Vitamin K Deficiency Causing Coagulation Dysfunction in an Older Patient with Pneumonia: A Case Report

Neglected vitamin K deficiency causing coagulation dysfunction in an older patient with pneumonia: a case report

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