Spontaneous Knee Hemarthrosis Due to Hypofibrinogenemia Following Tigecycline Treatment for Periprosthetic Joint Infection

Abstract

Tigecycline, a recently approved antibiotic, has a broad spectrum of antimicrobial activity. Its unique structure and properties make tigecycline a valuable option for the treatment of infections caused by many multidrug-resistant organisms. We present a case of an 82-year-old patient who developed a significant decrease of fibrinogen levels after the addition of tigecycline to his antibiotic regimen. The patient was treated for a periprosthetic knee joint infection caused by a multidrug-resistant extended-spectrum beta-lactamase-producing Escherichia coli. The reduction of fibrinogen levels, in this case, prompted severe spontaneous hemarthrosis. Tigecycline treatment was discontinued and coagulation disorders were normalized within the next few days. After several days, the joint had to be surgically debrided. Hypofibrinogenemia is a very scarcely reported side effect of tigecycline that can cause spontaneous hemarthrosis.

Incidence, characteristics and risk factors of hypofibrinogenemia associated with tigecycline: A multicenter retrospective study in China

“…Tigecycline-associated hypofibrinogenemia was first reported in a case study by Pieringer et al in 2010, which is currently a documented adverse event ( Pieringer et al, 2010 ). A retrospective study in China found a decrease in fibrinogen in patients treated with tigecycline ( Zhang et al, 2015 ) and several cases of potentially life-threatening coagulation disorders induced by tigecycline have also been reported ( Akalay et al, 2021 ; Balfousias et al, 2019 ; Fan et al, 2020 ; Rossitto et al, 2014 ; Routsi et al, 2015 ; Sabanis et al, 2015 ; Wu et al, 2017 ; Yılmaz Duran et al, 2018 ). However, although various reports have demonstrated an association between tigecycline and hypofibrinogenemia, the findings could not provide practical reference for clinical administration of tigecycline due to limitations such as small sample sizes, lack of a control group and insufficient description.…”

Risk factors of tigecycline-associated fibrinogen reduction in patients with renal transplantation: a case-control study

“…Campany-Herrero et al found that high-dose tigecycline treatment and treatment duration >4 weeks were risk factors for a reduction in fibrinogen plasma concentration >1.7 g/L (16). As previously reported, tigecycline-associated hypofibrinogenemia is reversible and the FIB level normalizes within days of tigecycline discontinuation (30).…”