Hemorrhagic diathesis induced by the administration of antibiotics in a case of SLE under hemodialysis

A 29-year-old woman with SLE nephropathy who was under hemodialysis developed a bleeding tendency after cefazolin (CEZ) administration. Since the excretion of this drug is considerably lowered in patients on hemodialysis, the drug is considered to be closely related to hemorrhagic diathesis. Several studies were made to elucidate the causal relationship of this drug to the hemorrhagic diathesis, and the following results were obtained: 1) No circulating anticoagulant was detected in the patient's plasma, 2) Among the blood-coagulating factors, only vitamin K dependent factors (II, IX and X factor) were decreased. 3) In patient's plasma, so-called protein-by-vitamin-K-absence (PIVKA) was detected, suggesting marked vitamin K deficiency. 4) Administration of vitamin K ameliorated the hemorrhagic diathesis in association with the disappearance of PIVKA from the circulation. 5) The plasma level of CEZ in this patient rose to 280μg/ml, an unexpectedly high level in individuals with nomal renal function. These findings suggest a causal relationship between CEZ and the vitamin K deficiency which is directly related to the hemorrhagic tendency. It is concluded that altered intestinal flora induced by the accumulation of CEZ played an etiologic role in the vitamin K deficiency.