Case Report(s)

---

A 72 year old elderly male who was a known case of COPD was admitted to the hospital with one week history of productive cough, exertional breathlessness and generalized body swelling suggestive of an acute exacerbation with congestive cardiac failure. Patient was in hypotension, X-ray chest revealed a consolidation in the right lower lobe, complete blood count showed leucocytosis and blood culture grew Pseudomonas aeruginosa. A diagnosis of sepsis syndrome was made and the patient was started on Ticarcillin Clavulanate and supportive therapy. Two days after treatment the patient developed a diffuse subcutaneous hemorrhage in the whole of the chest and the abdominal wall. (Figure A, B, C). Though the patient was not on any kind of antiplatelet or anticoagulant therapy still the development of hemorrhage was an enigma. Platelet count, bleeding and clotting time, prothombin time, activated partial thromboplastin time, hepatitis serology and liver functions were normal. A diagnosis of Timentin induced subcutaneous hemorrhage was made. The patient died after 5 days owing to multi organ failure. Timentin is known to cause thrombocytopenia, leucopenia, neutropenia, eiosinophilia, reduction of hemoglobin or hematocrit, abnormalities of coagulation, platelet aggregation and prolongation of prothrombin time and bleeding time more in patients with renal impairment. Subcutaneous bleeding manifestations have occurred acutely after the use of this drug at the injection sites though rare. Activated partial thromboplastin time (APTT) has been shown to increase with the use of Ticarcillin resulting in increased bleeding tendency [1-3].Treatment includes withdrawal of the offending drug and symptomatic treatment.

References

---

1. Jackson D, Cockburn A, Cooper DL, Langley PF, Tasker TCG, White DJ. Clinical pharmacology and safety evaluation of Timentin. Am J Med 1985; 79(5B): 44-55.
2. Croydon EAP, Hermoso C. An evaluation of the safety and tolerance of Timentin. J Antimicrob Chemother 1986; 17(c): 233-240.
3. Jungbluth GL, Cooper DL, Doyle GD, Chudzik GM, Jusko WJ. Pharmacokinetics of ticarcillin and clavulanic acid (Timentin) in relation to renal function. Antimicrob Agents Chemother 1986; 30(6): 896-900.

Source(s) of Funding

---

No source of funding

Competing Interests

---

No competing interests