Key result
Concurrent warfarin therapy and antibiotic administration precipitated supratherapeutic INR (6.95) and subsequent diffuse alveolar hemorrhage in a 29-year-old female.
Case Report (n=1)
This case highlights the risk of diffuse alveolar hemorrhage due to supratherapeutic INR when warfarin is co-administered with antibiotics like IV Vancomycin.
May warrant closer INR surveillance with warfarin-antibiotic co-use; single case leaves open population-level risk assessment.
A 29-year-old female presented with facial cellulitis. Past medical history includes DVT of the right upper extremity secondary to PICC line for which she was receiving coumadin. Physical exam was notable for facial pustular cellulitis and she showed good response with IV Vancomycin but subsequently developed progressively worsening dyspnea with hypoxia. Auscultation of chest revealed bilateral scattered crackles with poor bilateral air entry. CXR showed bilateral interstitial markings of the lungs, with a diffuse nodular pattern. The labs revealed drop in Hct and INR of 6.95. CT angiogram showed diffuse ill-defined interstitial opacities with nodular appearance. Bronchoalveolar lavage revealed bloody aliquots consistent with DAH secondary to supratherapeutic INR. Coumadin was discontinued and steroids were administered for a potential capillaritis and the patient responded well. This case highlights a relatively unusual presentation of DAH due to supratherapeutic INR, which was likely precipitated by concurrent warfarin therapy and antibiotic administration.
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A 2010 study conducted a case report in Diffuse alveolar hemorrhage (n=1). Warfarin and concurrent antibiotic administration was evaluated on Diffuse alveolar hemorrhage. Concurrent warfarin therapy and antibiotic administration precipitated supratherapeutic INR (6.95) and subsequent diffuse alveolar hemorrhage in a 29-year-old female.
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