Ciprofloxacin/vitamin K

Abstract

Hyperfibrinolysis, hepatotoxicity and lack of efficacy: case reportA 47-year-old man developed hyperfibrinolysis and hepatotoxicity during treatment with ciprofloxacin. Additionally, he exhibited lack of efficacy during treatment with vitamin K for hyperfibrinolysis.The man, who had alcoholic cirrhosis, presented to the emergency department with right groin pain. He had been receiving ciprofloxacin [route and dosage not stated] for K.oxytoca and P. rettgeri bacteremia. On admission a physical examination showed tenderness of the right groin with passive and active range-of-motion, right groin haematoma and diffuse petechiae. CT scans of abdomen and pelvis showed moderate ascites and retroperitoneal haematoma secondary to psoas tear centering near the distal right psoas. His INR was >27.0 [duration of treatment to reaction onset not stated].Then, the man received vitamin K [route and dosage not stated]; however, it failed to improve coagulopathy in setting of worsening anemia. Later, he was treated with vitamin K, unspecified cryoprecipitates and fresh frozen plasma. Additional studies showed undetectable fibrinogen, increased D-dimer and increased INR. These findings were consistent with hyperfibrinolysis related to ciprofloxacin. Subsequently, he was treated with aminocaproic acid [e-aminocaproic acid]. Eventually, a transient improvement in coagulopathy was noted. Later, he experienced worsening coagulopathy. He was discharged on hospice and died after 72 hours [an exact cause of death not stated]. Later, it was confirmed that his hepatotoxicity was associated with ciprofloxacin.Schubert LR, et al. Hyperfibrinolysis in the setting of retroperitoneal hematoma secondary to psoas tear in patient with decompensated liver cirrhosis and possible hepatotoxicity from ciprofloxacin.