Toxic epidermal necrolysis syndrome induced by tigecycline: a case report

Impact of Tigecycline on Coagulation in Severe Infections and Effect of Vitamin K1 Intervention: A Retrospective Single-Center Analysis

BACKGROUND Tigecycline is a tetracycline antibiotic used to treat gram-positive and gram-negative bacterial infections, and bleeding is a dose-dependent adverse effect. Vitamin K1 is a fat-soluble vitamin used to treat hemorrhagic conditions. This retrospective study from a single center included 920 patients treated with tigecycline for bacterial infections between January 2017 and December 2022 and aimed to evaluate the incidence of coagulopathy and the use of vitamin K1. MATERIAL AND METHODS A total of 220 patients were included and divided into a high-dose group (100 mg, every 12 h) and normal-dose group (50 mg, every 12 h) according to the treatment dose of tigecycline. Clinical characteristics and changes in coagulation indicators during tigecycline treatment were collected. Seventy-two patients were treated with vitamin K1, and the changes in coagulation indicators before and after treatment were compared. ANOVA and t test were used to analyze the effects of different doses of tigecycline on coagulation function and the intervention of vitamin K1. RESULTS Among 920 patients, the incidence of coagulopathy was 23.91%. In both groups, coagulopathy occurred on days 5 to 7 after administration, and the high-dose group had worse coagulation function than the normal-dose group, including activated partial thrombin time, prothrombin time, and fibrinogen (P<0.05). After treatment with vitamin K1, fibrinogen increased and activated partial thrombin time and prothrombin time were shortened in both groups (P<0.05 or P<0.01). CONCLUSIONS Tigecycline caused coagulopathy with dose and time dependence. Vitamin K1 can improve tigecycline-induced coagulopathy.

Toxic Epidermal Necrolysis Induced by Doxycycline: A Case Report and Literature Review

Lyell syndrome, also known as toxic epidermal necrolysis (TEN), is a rare but life-threatening skin condition, often triggered by certain medications. Antiepileptics, allopurinol, and some nonsteroidal anti-inflammatory drugs are the most common causes. Some antibiotics are also common culprits, although tetracyclines are rarely linked to this condition. We hereby report a case of TEN induced by doxycycline in an 18-year-old girl who was taking the drug for the treatment of acne.