Int J Clin Pharmacol Ther. 2023 Oct;61(10):466-470. doi: 10.5414/CP204337.
We describe a case of acute pancreatitis (AP) and hypofibrinogenemia associated with drug treatment with the aim to increase awareness of uncommon yet possibly life-threatening adverse reactions of tigecycline and furosemide.
A 75-year-old Chinese male was hospitalized for acute non-ST-elevation myocardial infarction and acute heart failure. The patient underwent successful percutaneous coronary intervention and MitraClip. Furosemide was taken since admission. Because was detected in the blood and sputum, the patient was treated with tigecycline from the 14 day of hospitalization. Abnormal pancreatitis parameters were observed, and pancreatic CT was undertaken 12 days after the treatment of tigecycline. AP was diagnosed and symptomatic treatment was carried out, but no significant improvement was observed. On the 33 day of hospitalization, the patient presented with acute upper gastrointestinal bleeding and decreased levels of fibrinogen and platelets. After withdrawal of tigecycline, the coagulation and pancreatitis parameters improved significantly. However, the pancreatitis parameters increased again after stopping somatostatin. Therefore, somatostatin was given again for 1 day, and furosemide was discontinued. After that, the pancreatitis parameters returned to baseline levels after a slight recovery.
Clinicians should pay attention to clinical signs, symptoms, and pancreatic enzymes during tigecycline or furosemide treatment, especially when used in combination. In addition, regular monitoring of fibrinogen and platelet count during tigecycline treatment is suggested.
我们描述了一例与药物治疗相关的急性胰腺炎（AP）和低纤维蛋白原血症，旨在提高对替加环素和呋塞米罕见但可能危及生命的不良反应的认识。
一名 75 岁的中国男性因急性非 ST 段抬高型心肌梗死和急性心力衰竭住院。患者接受了成功的经皮冠状动脉介入治疗和二尖瓣夹合术。入院后开始使用呋塞米。由于血液和痰中检测到 ，患者从住院第 14 天开始接受替加环素治疗。观察到异常的胰腺炎参数，并在接受替加环素治疗 12 天后进行了胰腺 CT 检查。诊断为 AP 并进行了对症治疗，但未观察到明显改善。住院第 33 天，患者出现急性上消化道出血和纤维蛋白原和血小板水平降低。停用替加环素后，凝血和胰腺炎参数明显改善。然而，停用生长抑素后胰腺炎参数再次升高。因此，再次给予生长抑素治疗 1 天，并停用呋塞米。此后，在纤维蛋白原和血小板计数略有恢复后，胰腺炎参数恢复到基线水平。
临床医生在使用替加环素或呋塞米治疗时应注意临床体征、症状和胰腺酶，特别是在联合使用时。此外，建议在替加环素治疗期间定期监测纤维蛋白原和血小板计数。
