Submited on: 17 Jun 2014 12:14:20 PM GMT
Published on: 17 Jun 2014 12:25:56 PM GMT
Ticarcillin Sodium/Potassium Clavulanate (Timentin) Induced Subcutaneous Hemorrhage - A Case Report
Posted by Dr. Robert J Mahoney on 26 Jul 2014 08:19:20 PM GMT Reviewed by Author Invited Reviewers

  • What are the main claims of the paper and how important are they?

    Idiopathic subcutaneous hemorrhage occurred in a patient during therapy with ticarcillin clavulanate without evidence of accompanying coagulopathy.

  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Bleeding has been reported previously during therapy with broad spectrum penicillins (see Fass, RJ et al. Platelet-mediated bleeding caused by broad-spectrum penicillins. J Infect Dis. 1987 Jun;155[6]:1242-8). Reports of spontaneous bleeding without abnormalities in coagulation are rare.

  • Are the claims properly placed in the context of the previous literature?

    Yes, although alternative explanations (e.g., vasculitis, cutaneous infection, etc.) were not conclusively excluded.

  • Do the results support the claims? If not, what other evidence is required?

    Skin biopsy or postmortem evaluation would be more conclusive.

  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    A literature search strategy would be helpful.

  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    A more detailed patient exposition (HPI, PMHx, FSHx, etc.) would be more traditional for a case report. Surgical pathology or postmortem examination would be very contributory, although this is likely precluded by the time that has passed. Detailed laboratory results in tabular format would be supportive.

  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    This level of detail is appropriate for a poster; with more detail, would be appropriate for publication.

  • Other Comments:


  • Competing interests:
  • Invited by the author to review this article? :
  • Have you previously published on this or a similar topic?:
  • References:


  • Experience and credentials in the specific area of science:

    Ongoing clinical work including care for patients with infectious diseases.

  • How to cite:  Mahoney R J.Ticarcillin Sodium/Potassium Clavulanate (Timentin) Induced Subcutaneous Hemorrhage - A Case Report[Review of the article 'Ticarcillin Sodium / Potassium Clavulanate (Timentin) Induced Subcutaneous Hemorrhage - A Case Report ' by Rather A].WebmedCentral 2014;5(7):WMCRW003086
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1. Very little literature is available on this topic. Though a skin biopsy would have been desirable cosidering the wish of the relatives of the deceased no postmortem was conducted.

2. About vasculitis beingb a differential diagnosis I want to add that the patient historically had COPD and the lesions mentioned therein developed only after the start of antibiotic therapy and the patient never ever had complained of the development of a similar lesion that would suggest vasculitis nor had he any symptom or sign that would point towards vasculitis as a reason for subcutaneous hemorrhage.

Responded by Dr. Ishrat H Dar on 29 Jul 2014 10:06:25 AM