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[A case of hematuria associated with cefem group antibiotics]
H Okuno1, K Okamoto, T Fukuyama
1Department of Urology, Kyoto National Hospital.
Abstract:
The patient was a 76-year-old male with disturbance of consciousness due to cerebral infarction. He was found lying in his garden on July 30, 1990 and was immediately hospitalized. Central venous alimentation was started on the same day, because the patient was incapable of oral nutritional intake. Aspiration pneumonia developed on August 3. As Pseudomonas aeruginosa and Candida were detected by sputum cultures on August 20, antibiotics were changed to latamoxef (LMOX), 6 g/day, tobramycin, 180 mg/day, and fluconazole, 200 mg/day, from August 30. Macroscopic hematuria was noted after exchange of the urethral catheter. Hematuria gradually worsened, bladder tamponade occurred, and anemia had exacerbated with Hb decreasing from 13.4 to 8.7 g/dl and Hct from 39.1 to 26% on September 14, when the patient was referred to our department. Corresponding marked increases were observed in PT from 11.5 to 50.1 seconds and in APTT from 33.7 to 107.6 seconds. As the hematuria was suspected to be due to vitamin K deficiency hypoprothrombinemia induced by LMOX, its administration was discontinued on the day of the referral. Hematuria was alleviated from the next day, and PT normalized to 12.1 seconds and APTT to 36.6 seconds 3 days after discontinuation. The administration of vitamin K was started on this day, and hematuria disappeared 7 days after discontinuation of LMOX administration.
Insights
Latamoxef (LMOX) antibiotic treatment in a patient with cerebral infarction and pneumonia led to severe hematuria due to vitamin K deficiency. Discontinuation of LMOX and vitamin K administration resolved the bleeding.
Area of Science:
- Internal Medicine
- Pharmacology
- Infectious Diseases
Background:
- A 76-year-old male with cerebral infarction and aspiration pneumonia required central venous nutrition and broad-spectrum antibiotics.
- Treatment included latamoxef (LMOX), tobramycin, and fluconazole for Pseudomonas aeruginosa and Candida infections.
Observation:
- The patient developed severe, worsening macroscopic hematuria and anemia after a urethral catheter exchange.
- Coincidental marked increases in prothrombin time (PT) and activated partial thromboplastin time (APTT) were observed.
Findings:
- The hematuria and coagulopathy were suspected to be induced by latamoxef (LMOX), likely due to vitamin K deficiency hypoprothrombinemia.
- Discontinuation of LMOX led to rapid improvement in hematuria and normalization of PT and APTT.
Implications:
- Latamoxef (LMOX) can induce vitamin K deficiency, leading to severe bleeding complications, particularly in vulnerable patients.
- Prompt recognition and management, including LMOX discontinuation and vitamin K supplementation, are crucial for resolving LMOX-induced coagulopathy and hematuria.