替加环素致低纤维蛋白原血症1例

A case hypofibrinogenemia resulted from tigecycline

1例39岁男性因下肢感觉减退1年余,腹胀6月入院。结合单克隆免疫球蛋白(IgMλ)、血清血管内皮生长因子(VEGF)水平等检查,多发周围神经病变、肝脾肿大、内分泌腺功能减退、皮肤改变、多浆膜腔积液等临床表现,确诊为POEMS综合征,予以来那度胺联合地塞米松化疗。治疗期间患者出现医院获得性肺炎,痰培养回报泛耐药鲍曼不动杆菌,根据药敏结果调整抗菌方案为替加环素联合哌拉西林/舒巴坦治疗3 d后患者体温恢复正常。使用替加环素第10天,患者出现纤维蛋白原(Fbg)明显减低,伴凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)显著延长,停药后第3天纤维蛋白原迅速恢复正常。提示出现替加环素相关的低纤维蛋白原血症。

A 39-year-old man was hospitalized due to numbness of low extremities for 1 year and abdominal distension for 6 months. With laboratory tests of monoclonal protein(IgMλ), VEGF levels, and clinical manifestations showing as polyneuropathy, organomegaly, endocrinopathy,skin changes, and polyserositis, this patient was diagnosed as POEMS syndrome treating with lenalidomideplus dexamethasone. During hospitalization,the patient developed hospital-acquired pneumonia(HAP). According to drug sensitivity test results which showed pan-resistant Acinetobacter baumannii in the sputum culture, the antimicrobial regimen was adjusted as tigacycline combined with piperacillin sulbactam. After 3 days of treatment, the patient’s temperature returned to normal. However, on the 10th day of tigacycline administration, fibrinogen(Fbg) was significantly decreased, with prolonged prothrombin time(PT), activated partial prothrombin time(APTT) and thrombin time(TT). On the 3rd day of discontinuance of tigecycline, the fibrinogen level came backto normal within 3 days, suggesting tigecycline related hypofibrinogenemia.