Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Jan 21:2019:3574064.
doi: 10.1155/2019/3574064. eCollection 2019.

A Case of Alveolar Bleeding from Clotting Abnormality by Cefmetazole

Eri Nakano  1 , Tsubasa Fukuoka  1 , Nao Takeuchi  1 , Tomoyuki Seki  1 , Michihiro Tamai  1 , Makoto Araki  1
Affiliations
Case Reports

A Case of Alveolar Bleeding from Clotting Abnormality by Cefmetazole

Eri Nakano et al. Case Rep Med. .

Abstract

Cephalosporins are one of the most commonly used first-line antibiotics. In this report, we describe the case of a patient who developed alveolar bleeding due to clotting abnormality following the use of cefmetazole, one of cephalosporins containing an N-methylthiotetrazole (NMTT) side chain. Compared to other antibiotics, cephalosporins with an NMTT side chain cause a higher degree of bleeding events. The bleeding tendency is caused by the depletion of vitamin K-dependent clotting factors via inhibition of the vitamin K epoxide reductase. This mechanism of action is the same as warfarin. Recent years have seen an increase in the number of patients using direct oral anticoagulants that do not require coagulation tests. As a consequence, there may be an increase in the number of bleeding events due to anticoagulant drugs and such antibiotics coprescription. Therefore, this case is an instructive lesson.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Chest CT at the time of admission (a) and 14th hospital day (b).
Figure 2
Figure 2
Evolution of prothrombin time values after admission.
Figure 3
Figure 3
Vitamin K cycle. Warfarin and cefmetazole mainly suppresse vitamin K epoxide reductase.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Breen G. A., Peter W. L. S. Hypoprothrombinemia associated with cefmetazole. Annals of Pharmacotherapy. 2017;31(2):180–184. doi: 10.1177/106002809703100210. - DOI - PubMed
    1. Shearer M. J., Bechtold H., Andrassy K., et al. Mechanism of cephalosporin-induced hypoprothrombinemia: relation to cephalosporin side chain, vitamin K metabolism, and vitamin K status. Journal of Clinical Pharmacology. 2013;28(1):88–95. doi: 10.1002/j.1552-4604.1988.tb03106.x. - DOI - PubMed
    1. Spence T. H., Connors J. C. Diffuse alveolar hemorrhage syndrome due to ‘silent’ mitral valve regurgitation. Southern Medical Journal. 2000;93(1):65–67. doi: 10.1097/00007611-200001000-00012. - DOI - PubMed
    1. Leung W.-H., Lau C.-P., Wong C.-K., Cheng C.-H. Fatal massive pulmonary hemorrhage complicating mitral stenosis. Clinical Cardiology. 1990;13(2):136–138. doi: 10.1002/clc.4960130214. - DOI - PubMed
    1. Erdogan D., Kocaman O., Oflaz H., Goren T. Alveolar hemorrhage associated with warfarin therapy: a case report and literature review. International Journal of Cardiovascular Imaging formerly The International Journal of Cardiac Imaging. 2004;20(2):155–159. doi: 10.1023/b:caim.0000014101.06445.66. - DOI - PubMed

Publication types