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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.

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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

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