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Case Reports
. 2022 Jul 13;35(6):868-870.
doi: 10.1080/08998280.2022.2095859. eCollection 2022.

Cefazolin-induced hypoprothrombinemia

Mallory Smith  1 , James Doyle  1 , Cameron Crane  1 , Charles Bussell  1
Affiliations
Case Reports

Cefazolin-induced hypoprothrombinemia

Mallory Smith et al. Proc (Bayl Univ Med Cent). .

Abstract

Long-term antibiotic use can be associated with a myriad of side effects, ranging from relatively benign to life-threatening. The most common side effects of cephalosporins include dermatologic reactions and diarrhea. Here, we present a rarer side effect: a spontaneous retroperitoneal hematoma in the setting of cefazolin administration for vertebral osteomyelitis. Several cephalosporins have been implicated in coagulopathy secondary to hypoprothrombinemia. However, only a few case reports have implicated cefazolin, and all have occurred in the context of acute or chronic renal failure. Our case of cefazolin-induced coagulopathy occurred in a patient with normal renal function.

Keywords: Cefazolin; cephalosporin; coagulopathy.

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Figures

Figure 1.
Figure 1.
(a) Chemical structure of moxalactam with MTT group highlighted. (b) Chemical structure of cefazolin with MTD group highlighted.
Figure 2.
Figure 2.
Large left retroperitoneal hematoma indicated by arrow.
Figure 3.
Figure 3.
Gamma-carboxylation of glutamic acid oxidizes vitamin K, promoting activation of clotting factors. MTD metabolites from cefazolin inhibit gamma-glutamyl carboxylase, thus decreasing clotting factor formation. The enzyme TPMT adds an S-methyl group to MTD, reducing its ability to inhibit gamma-glutamyl carboxylase.
See this image and copyright information in PMC

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