Rapid-onset of severe tigecycline-induced coagulopathy in drug reaction with eosinophilia and systemic symptom syndrome

Yeong Jin Jeong; Byeongzu Ghanh; Ji Wan Lee; Jinoh Park; Tae-Bum Kim; You Sook Cho; Hee-Bom Moon; Hyouk-Soo Kwon

doi:10.4168/aard.2016.4.1.74

Journal List > Allergy Asthma Respir Dis > v.4(1) > 1059235

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Jeong, Ghanh, Lee, Park, Kim, Cho, Moon, and Kwon: Rapid-onset of severe tigecycline-induced coagulopathy in drug reaction with eosinophilia and systemic symptom syndrome

Case Report

Allergy, Asthma & Respiratory Disease 2016; 4(1): 74-78.

Published online: 29 January 2016

DOI: https://doi.org/10.4168/aard.2016.4.1.74

Rapid-onset of severe tigecycline-induced coagulopathy in drug reaction with eosinophilia and systemic symptom syndrome

Yeong Jin Jeong¹, Byeongzu Ghanh¹, Ji Wan Lee¹, Jinoh Park¹, Tae-Bum Kim², You Sook Cho², Hee-Bom Moon², Hyouk-Soo Kwon²

¹Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Correspondence to: Hyouk-Soo Kwon. Department of Internal Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3280, Fax: +82-2-3010-6969, kwonhs21@naver.com

Received 16 August 2015 Revised 29 September 2015 Accepted 12 October 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome—also known as drug-induced hypersensitivity syndrome—is an uncommon disease entity that manifests as fever, skin rash, blood cell abnormalities, lymphadenopathy, and often coagulopathy. Tigecycline is an antibiotic that is selectively used to treat complicated intra-abdominal and soft-tissue infections. Recently, a few cases of tigecycline-induced coagulopathy have been reported. Herein, we report a case of tigecycline-induced coagulopathy in a patient with DRESS syndrome. Both prothrombin time and activated partial thromboplastin time were abruptly exceeded beyond 180 seconds on day 6 of tigecycline treatment and normalized after discontinuation of tigecycline.

Keywords: DRESS syndrome, Tigecycline, Coagulopathy

Figures and Tables

Fig. 1

Generalized maculopapular rash and petechiae on the lower extremities

Fig. 2

High-resolution chest computed tomography images showing pulmonary edema (A) and mediastinal lymphadenopathy (B; arrow, mediastinal lymphadenom). DRESS syndrome can manifest interstitial pneumonia and pleural effusion.

Fig. 3

Skin biopsy showing dermatitis with perivascular lymphocytic and eosinophilic infiltration (H&E, ×400).

Table 1

Coagulation profiles on select days in the hospital

Variable	Day 1^*	Day 2	Day 3	Day 4	Day 5	Day 6	Day 7	Day 8	Day 9	Day 10	Day 12	Day 39
PLT ( × 10⁶ µL)	72	45	13	30	18	20	14	22	94	65	38	197
PT (sec)	-	13.3	13.5	14.6	14.0	180	13.4	13.0	180	12.4	12.0	10.7
PT (INR)	1.01	1.24	1.26	1.37	1.29	18.88	1.35	1.19	18.80	1.13	1.12	0.97
aPTT (sec)	36.0	47.7	49.3	38.4	41.2	180.0	32.3	31.3	180.0	32.6	28.9	24.2
Fibrinogen (mg/dL)	-	171	-	107	87	25	79	70	25	75	93	-
Transfusion			PC	FFP	PC	FFP	PC	PC	PC	CP
			16U	2U	16U	6U	24U	8U	8U	6U
				PC		PC	CP		FFP	PC
				24U		8U	6U		6U	8U
						CP			CP
						6U			6U
Days of tigecycline use	1	2	3	4	5	6	7	8	9	-	-	-
Days after discontinuation of tigecycline	-	-	-	-	-	-	-	-	-	1	3	30

PLT, platelet; PT, prothrombin time; INR, International normalized ratio; aPTT, activated partial thromboplastin time; PC, platelet concentration; FFP, fresh frozen plasma; CP, cryoprecipitate.

^*Day 1 test was done in emergency department and day 2 result was considered as initial result in admission.

Table 2

Comparison of reported cases of tigecycline-induced coagulopathy

Source	Comorbidity	Indication for tigecycline	Days of tigecycline	PT (sec)	INR	Fibrinogen (mg/dL)
Sabanis et al.4	ESRD	SSI	10	120	6.33	297
Sabanis et al.4	ESRD	SSI	19	18.8	1.71	42
Pieringer et al.3	ESRD	Peritonitis	15	-	1.50	-
			35	-	1.76	38
			39	-	3.08	30
Rossitto et al.5	LC with AKI	Severe septic shock	6	-	2.70	50
Rossitto et al.5	LC with AKI	Severe septic shock	7	Indeterminate	-	25

PT, prothrombin time; INR, International normalized ratio; ESRD, end stage of renal disease; SSI, surgical site infection; LC, liver cirrhosis; AKI, acute kidney disease.

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ORCID iDs: Hyouk-Soo Kwon
https://orcid.org/http://orcid.org/0000-0001-7695-997X
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