Okajima A, Horii J, Nasu K, Niki Y, Akasaka K, Yamashita H, Sugimoto M, Yoshioka A
Rinsho Ketsueki. 1989 Apr;30(4):514-9.
A 84-year-old man was admitted with palpitation, edema of legs and anemia during a long course of diabetes mellitus, prostatic hypertrophy and prostatic cancer. He revealed purpura on the hands and massive microhematuria. He had received antibiotic therapy for a urinary tract infection for a period of time, but he had no history of hemorrhagic tendency or blood transfusion. Coagulation studies showed the prolongation of whole blood clotting time and PT (prothrombin time). Activity of factor V was 14% of that normal control plasma. The titer of factor V inhibitor was 4.9 Bethesda units/ml. The inhibitor of the patient was supposed to belong to IgA and IgG judging from inhibitor neutralization test. PT was improved after discontinuance of administration of antibiotics and administration of azathioprine. Moreover, even after administration of prednisolone with antibiotics, PT and activity of factor V recovered to normal range. He died from respiratory failure. Autopsy revealed double cancer of prostate and descending colon. The appearance of factor V inhibitor was likely caused by antibiotics, double cancer, and age-related immune disorders.
一名84岁男性因长期患有糖尿病、前列腺肥大和前列腺癌，出现心悸、腿部水肿和贫血而入院。他双手出现紫癜并伴有大量镜下血尿。他曾接受过一段时间的抗生素治疗以治疗尿路感染，但他没有出血倾向或输血史。凝血研究显示全血凝血时间和PT（凝血酶原时间）延长。因子V活性为正常对照血浆的14%。因子V抑制剂滴度为4.9贝塞斯达单位/毫升。根据抑制剂中和试验判断，患者的抑制剂应属于IgA和IgG。停用抗生素并给予硫唑嘌呤后，PT有所改善。此外，即使在使用泼尼松龙联合抗生素治疗后，PT和因子V活性也恢复到正常范围。他死于呼吸衰竭。尸检发现前列腺和降结肠双癌。因子V抑制剂的出现可能是由抗生素、双癌以及年龄相关的免疫紊乱引起的。
