Endocrine Abstracts

Drug-induced hypoglycemia is a major clinical concern. Antibiotics are one of the causative agents to cause hypoglycemia. Tigecycline, which is a glycylcycline antibiotic, has a broad spectrum of activity, including activity against drug-resistant gram-positive and negative organisms. It´s side effects are significant but hypoglycemia and severe hypoglycemia is a rare finding during treatments. Our aim is to present an event of severe hypoglycemia in a patient with type 2 diabetes mellitus with replacement renal therapy, hemodialysis after initiating tigecycline.

Case presentation: A 54 years old female diagnosed with tip 2 diabetes mellitus was under treatment with basal-bolus insulin-therapy and oral antihypertensive drugs. She started hemodialysis 24 months ago. She complained of recurrent fever since the last 7 months and was treated with several antibiotics. In two separated blood cultures patient resulted positive for methicillin-resistant Staphylococcus epidermidis (MRSE). Based on antibiogram, we started treatment with tigecycline 100 mg/day. After 6-8 hours from the first dose, patient complicated with events of hypoglycemia and then continues with of severe hypoglycemia (40-47 mg/dl). Laboratory investigations showed: hemoglobin level 10 g/dl; total WBCc 14.68×10⁹/l (neutrophils 82%, lymphocytes 17%); platelet count 230 K/uL (150-400); blood urea 277.83 mg/dl (0-50); serum creatinine 12.0 mg/dl (0.57-1.11); serum sodium 140.00 mEq/l (136 – 148); potassium 6.6 mEq/l (3.7-5.5); calcium 9.14 mg/dl (8.4 - 10.2); HbA1c 6.5% and procalcitonin level was 2.01 ng/ml. The patient continued to have hypoglycemia for about 16-18 hours after the last dose. We didn’t find any reasons to explain the cause of episodes of hypoglycemia. Her insulin-like growth factor (IGF-1) was normal at 206.0 nmol/l (49.6–204), C peptide levels was 1.82 ng/ml (< 5.19), cortisol levels was 724 nmol/l (68.2-327) and ACTH level was 25.70 pg/ml (7.2 - 63.3). Patient didn’t have high level of insulin in the blood (insulin 4.11 mIU/l range 2.6-24.9).

Conclusions: We report a case of a diabetic patient with end stage renal disease on hemodialysis that experienced severe hypoglycemia episodes induced by tigecycline. To our knowledge, this is one of the limited case reports of sustained severe hypoglycemia due to tigecycline. Severe hypoglycemia is a serious event and immediate intervention is needed to correct it otherwise the outcome can be fatal.