Case report of vancomycin-induced pancytopenia

Gupta, Sorab; Sharma, Shalu; Menon, Nandini; Ahuja, Shradha; Dahdouh, Michelle

doi:10.1590/0037-8682-0263-2015

Cited by 4 publications

(3 citation statements)

References 7 publications

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“…Vancomycin is known to have a 2% to 3% chance of being associated with neutropenia, and a less than 1% chance of causing thrombocytopenia [2]. Taking into consideration the Naranjo [3] adverse drug reaction (ADR) probability scale, there is a probable association between vancomycin and neutropenia [4,5] as well as between vancomycin and thrombocytopenia [2,6]. The Naranjo ADR probability scale ranges from doubtful to possible, probable and definite.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, a 2018 case report by Gniadek and a 2007 clinical report by Drygalski describe a mechanism of immune thrombocytopenia involving vancomycin dependent platelet reactive antibodies [6,10]. Pancytopenia has also been described to be more likely with both slow and fast rates of infusion as well as lengthy duration of vancomycin infusion [1,4]. Aplastic anemia has been identified in observational studies involving medications such as carbamazepine, methimazole, phenytoin and sulfonamides, whereas chloramphenicol, dapsone and lithium have been mentioned in case reports [9].…”

Section: Discussionmentioning

confidence: 99%

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Pancytopenia as a Consequence of Sepsis and Intravenous Antibiotic Drug Toxicity

Cho

Avera

Iyamu

2019

Cureus

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This case involves a 62-year-old male with a prior history of epidural abscess and L1-L2 osteodiscitis who was admitted because of low back pain. The patient was previously treated for methicillin-susceptible Staphylococcus aureus (MSSA) discitis in the L1/L2 vertebral region with intravenous (IV) nafcillin through a peripherally inserted central catheter (PICC). However, he returned after four months with recurrent low back pain along with chills and fever. He was admitted for severe sepsis related to the L1-L2 region osteomyelitis and discitis. The Infectious Disease department initially started the patient on IV vancomycin and cefepime; however, routine labs on the second day of IV antibiotics showed concern for pancytopenia with white blood cell count (WBC) decreased to 2.5 thou/mm 3 , Hgb to 6.2 g/dL, Hct to 20.8%, and platelets to 82 thou/mm 3 from baseline values of WBC 3.9 thou/mm 3 , Hgb 8.3 g/dL, Hct 28%, and platelets 126 thou/mm 3 . Due to concern for pancytopenia in the setting of severe sepsis, extensive hematologic workup was pursued to evaluate for disseminated intravascular coagulation (DIC) and bone marrow suppression. The patient also had a positive fecal occult blood test, so the Gastroenterology department was consulted for esophagogastroduodenoscopy (EGD) and colonoscopy. Furthermore, despite appropriate outpatient treatment for MSSA osteodiscitis, the patient was bacteremic with Staphylococcus aureus. Hence, the Cardiology department was consulted to rule out cardiac valvular vegetation. This case presents a unique case of pancytopenia involving elements of drug-induced aplastic anemia as well as DIC-related sepsis. The agranulocytosis may have been a consequence of drug reaction to IV vancomycin. The anemia and thrombocytopenia may have been caused by DIC. Repeat computed tomography (CT) guided spinal aspiration confirmed pan-sensitive Staphylococcus aureus infection of the L1/L2 vertebral region. Treatment was reverted to nafcillin monotherapy and fortunately his hematologic function normalized, avoiding the need for advanced treatments such as intravenous immunoglobulin infusion therapy (IVIG) or high dose steroids.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pancytopenia as a Consequence of Sepsis and Intravenous Antibiotic Drug Toxicity

Cho

Avera

Iyamu

2019

Cureus

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“…Thus, it is necessary to discontinue vancomycin immediately in patients who are clinically suspected of VIT, 12 and replacement with other drugs according to the results of drug sensitivity and the risk of drugs in young children should be considered. Blood transfusions, corticosteroids, and intravenous immunoglobulin are options, and plasma exchange can also be considered if thrombocytopenia is prolonged or accompanied by hemorrhagic signs and symptoms.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin-induced severe thrombocytopenia in a young infant

Chen

Wan

Yang

et al. 2018

Rev. Soc. Bras. Med. Trop.

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Vancomycin is a first-line drug for treating methicillin-resistant Staphylococcus aureus. Thrombocytopenia is a rare adverse reaction to vancomycin treatment, and there are no reports of vancomycin-induced thrombocytopenia (VIT) in infants. We describe the case of a 3-month-old girl who was diagnosed with purulent meningitis. After 13 days of treatment with vancomycin, her platelet count reduced to 8 × 10 9 /L. Vancomycin was discontinued, and intravenous methylprednisolone was administered. The platelet count returned to normal after 4 days. Patients, especially young children, receiving vancomycin for a long clinical course should undergo careful monitoring of laboratory indicators and blood tests.

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Vancomycin

2016

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Case report of vancomycin-induced pancytopenia

Cited by 4 publications

References 7 publications

Pancytopenia as a Consequence of Sepsis and Intravenous Antibiotic Drug Toxicity

Pancytopenia as a Consequence of Sepsis and Intravenous Antibiotic Drug Toxicity

Vancomycin-induced severe thrombocytopenia in a young infant

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