Rationale: Extensive off-label use may affect the safety profile of tigecycline . Tigecycline -associated hypofibrinogenemia is potentially life threatening, although the frequency of life-threatening reactions is unknown and their incidence is easily overlooked. We report a case of 2 instances of treatment with high-dose tigecycline , each of which presented with hypofibrinogenemia. Patient concerns: An 86-year-old male patient was treated twice with high-dose tigecycline and presented with hypofibrinogenemia both times. The decrease in fibrinogen occurred within 3 to 7 days of tigecycline treatment. Other coagulation parameters had slightly prolonged values. Diagnoses: Coagulopathy and hypofibrinogenemia. Interventions: We discontinued the tigecycline . Outcomes: The fibrinogen level normalized within 5 days after the withdrawal of tigecycline . Following 80 days of hospitalization, the patient was transferred to the rehabilitation hospital for further treatment. Lessons: We suggest routine strict monitoring of coagulation parameters, particularly fibrinogen. Attention should be paid to below-normal fibrinogen levels due to increased bleeding risk and severity of reaction at fibrinogen levels below 1 g/L.
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