minocycline and Disseminated-Intravascular-Coagulation

Herein, we report a 70-year-old male patient, with recurrent multiple hepatic abscesses, that was admitted to the internal medicine department for treatment of Carbapenem Resistant Escherichia Coli (CRE) bacteremia. The patient was treated with Tigecycline; few days later, he developed "Disseminated Intravascular Coagulation (DIC)" like coagulation study abnormality that seemed to be related to Tigecycline treatment. Upon discontinuing it, the DIC-like condition was resolved. Tigecycline should be considered as a possible etiological factor in patients with DIC-like, and this therapy should be withdrawn immediately in suspected cases.

Topics: Aged; Anti-Bacterial Agents; Disseminated Intravascular Coagulation; Humans; Male; Minocycline; Severity of Illness Index; Thrombocytopenia; Tigecycline

Hepatic actinomycosis is rare. We report an 86-year-old Japanese man with a 3-day history of high fever and anorexia who had an actinomycotic liver abscess complicated by disseminated intravascular coagulation (DIC). A definitive diagnosis was made when an Actinomyces species was cultured from aspirated pus. The clinical course was satisfactory. Treatment included prompt percutaneous drainage coupled with long-term intravenous administration of high-dose minocycline and piperacillin, combined with therapy for DIC. We reviewed 11 cases in Japan of Actinomyces involving the liver, including the case reported here. In most patients, there were no predisposing factors. Common symptoms and laboratory findings included fever, abdominal pain, leukocytosis, and elevated C-reactive protein. In 6 of the 11 patients a partial hepatectomy was performed because hepatic tumor was suspected. Five patients presented with a liver abscess. Hepatic actinomycosis should be considered in the differential diagnoses of pyogenic liver abscess and space-occupying lesions of the liver.

Topics: Actinomyces; Actinomycosis; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Liver Abscess; Male; Middle Aged; Minocycline; Penicillins; Piperacillin; Tomography, X-Ray Computed

A 77-year-old woman who have no past history, was admitted in a local hospital in Muroto City, Kochi, Japan, after several days of fever and severe general fatigue and generalized skin erythema. She was suspected to have Japanease spotted fever, which was a local pandemic disease. She was treated with minocycline immediately. The next day, she had consciousness disturbance and low blood pressure. Laboratory findings indicated disseminated intravascular coagulation (DIC) and multiple organ failure. She was referred to our hospital. An eschar was identified in the back of It. femur. Treatment included minocycline, ciprofloxain, gabexate mesilate, methylprednisolone, hemodialysis and mechanical ventilation. In spite of the avobe treatment, she died 3 days after admission of the local hospital. Though the serological test showed no positive antibody titer against Rickettsia japonica, Rickettsia japonica was isoleted from blood culture, to confirm Japanese spotted fever, Japanese spotted fever is generaly a curative disease with early diagnosis and minocycline. In this case, the patient died 3 days after proper diagnosis and treatment was started. We reported the second fatal Japanese spotted fever case in Japan.

Topics: Aged; Anti-Bacterial Agents; Ciprofloxacin; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Japan; Methylprednisolone; Minocycline; Multiple Organ Failure; Renal Dialysis; Respiration, Artificial; Rickettsia; Rickettsia Infections; Severity of Illness Index

Twenty-eight patients with Japanese spotted fever were clinically investigated. The diagnosis was determined by confirming an increase of specific antibody. All patients were treated with minocycline, and all recovered, excluding one patient with a fulminant course. Fever and exanthema were observed in all patients, and an eschar was pointed out in 20 (71%) patients. The platelet count was 10 x 10(4)/microl or lower in 8 (28%) patients. The fibrin degradation product (FDP)-level was abnormally high, 10 microg/ml or more, in 16 (57%) patients. The creatine kinase (CK) value was high in 14 of 22 patients, suggesting the presence of myositis. The leukocyte count, FDP, C-reactive protein, and soluble interleukin 2 receptor (sIL2-R) levels were significantly higher in severe cases. In the group without concomitant steroid therapy, mean times of 54.7 h and 101.4 h were required to reduce the temperature to 38 degrees C and 37 degrees C or lower, respectively, after the initiation of tetracycline treatment. There were 6 severe cases: 1 with disseminated intravascular coagulation, 2 with multiorgan failure, 1 with acute respiratory distress syndrome, and 2 with meningoencephalitis. These severe cases formed a group that required 6 or more days to initiate therapy after the onset (P < 0.005 vs non-severe group), showing that delay in diagnosis and therapy is the major cause of aggravation. In the 2 patients complicated by multiorgan failure, the sIL2-R level, produced by activated lymphocytes, was 10,000 U/ml or higher, suggesting that an sIL2-R level of more than 10,000 U/ml can be used as a marker of poor prognosis. It may be better that moderate to severe cases are treated with minocycline plus short-term steroid therapy.

Topics: Acute Disease; Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Disseminated Intravascular Coagulation; Female; Humans; Infant, Newborn; Male; Meningoencephalitis; Middle Aged; Minocycline; Multiple Organ Failure; Prevalence; Receptors, Interleukin-2; Respiratory Distress Syndrome, Newborn; Rickettsia; Rickettsia Infections

A previously healthy 48-year-old man presented to his primary care physician with high fever, dry cough and dyspnea. Pneumonia was diagnosed and intravenous administration of imipenem/cilastatin was begun, but his respiratory condition worsened and he was admitted to our hospital with severe hypoxia. A chest radiograph showed reticular opacity and consolidation in both lung fields. The case was complicated with disseminated intravascular coagulation. Analysis of the bronchoalveolar lavage fluid showed increases in the total cell counts and an elevated percentage of lymphocytes. Sputum, blood and bronchoalveolar lavage examinations failed to reveal etiology to explain his severe respiratory illness. Treatment consisted of mechanical ventilation and administration of steroid pulse-therapy and gabexate mesilate. On the basis of his clinical course, we suspected possible atypical pneumonia, and began therapy with intravenous minocyclin and oral erythromycin administration. On the third hospital day, the arterial blood gas data improved and the bilateral pulmonary infiltration on the chest radiographs disappeared. Using paired sera, we detected increases of 1.35 in ID for anti-Chlamydia pneumoniae IgG antibodies by ELISA, and arrived at a diagnosis of Chlamydia pneumoniae pneumonia.

Topics: Acute Disease; Chlamydophila Infections; Chlamydophila pneumoniae; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Erythromycin; Gabexate; Humans; Male; Methylprednisolone; Minocycline; Pneumonia, Bacterial; Respiration, Artificial; Respiratory Insufficiency; Treatment Outcome

Topics: Aged; Bites and Stings; Disseminated Intravascular Coagulation; Duodenal Ulcer; Humans; Male; Minocycline; Rickettsia Infections; Severity of Illness Index; Shock, Hemorrhagic; Treatment Outcome

A 49-year-old man was admitted to our hospital, with a diagnosis of multiple organ failure, on June 10, 2000. Physical examination revealed high fever, generalized maculopapular erythema, and an eschar on his lower leg. Laboratory findings revealed severe renal and liver dysfunction, disseminated intravascular coagulation (DIC), and markedly elevated soluble interleukin 2-receptor (sIL2-R) level (>10 000 U/ml). Administration of minocycline was started immediately, with a diagnosis of rickettsial infection. Simultaneously, anti-thrombin III and heparin were started to treat the DIC, and hemodialysis was also initiated. However, the day after admission, his consciousness level lapsed, to the level of coma, and blood pressure was less than 60 mmHg, indicating shock. Therefore, 500 mg of methylprednisolone was administered once; as a result, rapid pyretolysis and improvement of consciousness disturbance were achieved. Laboratory data indicative of inflammation gradually improved after a few days. Hemodialysis was required ten times. During the recovery period, the level of specific IgM antibody against Rickettsia japonica increased to x2560, and he was diagnosed as having Japanese spotted fever. On July 11, he was discharged without sequelae. The course in our patient was very severe, and treatment with minocycline alone may have resulted in a fatal outcome. The level of sIL2-R, which is produced by activated lymphocytes, was markedly increased. Therefore, markedly elevated lymphocyte activation and hypercytokinemia may have been present on admission. The short-term steroid therapy may have been effective in inhibiting the excessive activation of lymphocytes in the critical stage. In the severe form of Japanese spotted fever with organ failure, combination therapy with minocycline and short-term steroids may be very useful.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Antibodies, Bacterial; Disseminated Intravascular Coagulation; Humans; Immunoglobulin M; Male; Methylprednisolone; Middle Aged; Minocycline; Multiple Organ Failure; Receptors, Interleukin-2; Rickettsia; Rickettsia Infections; Serologic Tests

Topics: Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Disseminated Intravascular Coagulation; Female; Humans; Japan; Minocycline; Rickettsia; Rickettsia Infections

Topics: Benzamidines; Disseminated Intravascular Coagulation; Guanidines; Humans; Hydrocortisone; Male; Meningitis; Middle Aged; Minocycline; Pulmonary Fibrosis; Scrub Typhus