Reactions 1463, p14 - 3 Aug 2013

SCeftriaxone

Fatal acquired haemophilia? in an elderly patient:case report

A 66-year-old woman developed acquired haemophilia dueto anti-factor XIII inhibitors (AH13) after treatment withceftriaxone for neurosyphilis. She subsequently died.

The woman had neurosyphilis in 2010 and received aceftriaxone infusion [dosage not stated]. She presented with ahaematoma in her right hand in February 2011. Ceftriaxonehad been administered approximately 6 months prior tobleeding onset. She underwent incision of her haematoma andthe wound continuously oozed. She developed gingivalbleeding while brushing her teeth and epistaxis. She consulteda haematology department and tests revealed a slightlyprolonged activated partial thromboplastin time. Debridementof necrotic tissue of her right hand was performed and she hadrepeated postoperative bleedings. She developed anintramuscular haematoma in her right thigh and went intoshock. Factor XIII (FXIII) deficiency was suspected. Anammonia release assay showed FXIII activity of 52%.

The woman received prednisolone. She developed a diffusesubcutaneous haematoma from her waist to her thigh and anintramuscular haematoma in her left abdominal rectus. Shewas transferred to an ICU because of shock and a deteriorationof consciousness. Her abdominal haemorrhage expanded intoher frontal intrapelvic cavity and she developed intraperitonealhaemorrhage. She underwent haemodiafiltration and plasmaexchange but eventually died due to haemorrhagic shockwhich resulted from her intraperitoneal bleeding. Her deathoccurred within 2 months after her first bleeding episode.Results of FXIII activity available after her death revealedextremely low levels of activity. Tests also showed a stronglypositive result for an anti-FXIII inhibitor and assays showedanti-FXIII-A antibodies.

Author comment: "[D]rug-induced disorders cannot becompletely excluded from the underlying cause of thisAH13 case, because she had received [ceftriaxone] forneurosyphilis. . . This may be not a clear case of drug-inducedantibodies because [ceftriaxone] was administeredapproximately 6 months before the bleeding onset, andantibodies to [ceftriaxone] are not of autoantibody type butonly of the immune-complex type."Sugiyama H, et al. Aggressive fatal case of autoimmune hemorrhaphilia resultingfrom anti-Factor XIII antibodies. Blood Coagulation and Fibrinolysis 24: 85-9, No.1, Jan 2013. Available from: URL: http://dx.doi.org/10.1097/MBC.0b013e328358e8e7 - Japan 803090682

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Reactions 3 Aug 2013 No. 14630114-9954/13/1463-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved