Hypercoagulopathy with Piperacillin Administration in Osteomyelitis.

Abstract

A 51-year-old man with osteomyelitis developed acute renal failure and superior mesenteric venous (SMV)thrombosis after piperacillin (PIPC) treatment. Coagulation profile disclosed disseminated intravascular coagulation (DIC). The serum levels of IgE and eosinophil cationic protein showed significant increases, while a lymphocyte stimulation test with PIPC also demonstrated an extremely high index. These observations suggest that hypersensitivity to PIPC might play a role in the pathogenesis of acute renal failure and SMVthrombosis due to hypercoagulopathy. Withdrawal of PIPC and anticoagulation therapy resulted in clinical improvementand normalization of the affected laboratory data. This is the first report to describe PIPCinduced hypercoagulopathy.

Recurrent Abdominal Thrombosis Despite Heparin Thromboprophylaxis in a Patient With Transient Eosinophilia

“…Thrombocytopenia has been also described in the course of eosinophilia without thrombosis. 8 As in some of the other cases, [3][4][5] a definite reason for the eosinophilia of our patient could not be found but given the normality of her full blood count a year earlier, it should be considered transient. Interestingly, her thrombotic recurrences ensued despite LMWH prophylaxis, as in one of the patients described above 6 : also considering the patient that required thrombolysis for clot dissolution, 2 the hypercoagulable state associated TE is quite severe.…”

“…After 1 month, the eosinophilia, coagulopathy, and oliguria had all resolved. 4 A 40-year-old atopic woman with psoriasis developed an itchy rash after taking an unspecified antibiotic for cough and fever. The antibiotic was changed and steroids were given for a couple of weeks (not specified).…”

“…Her TCP resolved spontaneously over 2 years. The significance of TCP with eosinophilia-associated thrombosis remains obscure, although peripheral consumption culminating in DIC in some patients 3,4 seems a reasonable explanation. Thrombocytopenia has been also described in the course of eosinophilia without thrombosis.…”