A Case of Confirmed Ceftriaxone-induced Immune Thrombocytopenia

Abusharar, Shady Piedra; Shah, Neal; Patel, Ravi; Jain, Rohit; Polimera, Hyma

doi:10.7759/cureus.4688

Cited by 7 publications

(5 citation statements)

References 10 publications

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“…Indeed, drug-induced thrombocytopenia by cephalosporins has already been described. 11,12 Our case deserves attention for several reasons: the severe thrombocytopenia, uncommon until the later stages of COVID-19, 10 the maculopapular-petechial eruption, a rarely reported cutaneous manifestation, and, importantly, the presence of erosions and blood crusts on the inner mucosa of the lips and gingival-oropharyngeal petechiae. Such mucosal lesions have never been described during a SARS-CoV-2 infection.…”

mentioning

confidence: 91%

Oral erosions and petechiae during SARS‐CoV‐2 infection

Ciccarese

Drago

Boatti³

et al. 2020

Journal of Medical Virology

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To the Editor, An increasing number of reports have been written regarding cutaneous manifestations during the coronavirus disease-2019 (COVID-19), 1-3 though knowledge of the possible oral manifestations is still poor. This may be due to a lack of intraoral examinations, which may be caused by limited availability of the recommended protective measures and the use of telemedical consultations for SARS-CoV-2 infections. We describe a patient presenting with cutaneous and oral lesions associated with a SARS-CoV-2 infection. A previously healthy 19-year-old woman presented to the Emergency Department with a seven-day history of intermittent fever and sore throat. She had started taking oral cefixime (400 mg per day) 3 days earlier. She also reported a sudden onset of fatigue, hyposmia, and asymptomatic cutaneous and oropharyngeal lesions that started 2 days before admission. On

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mentioning

confidence: 91%

Oral erosions and petechiae during SARS‐CoV‐2 infection

Ciccarese

Drago

Boatti³

et al. 2020

Journal of Medical Virology

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“…Ceftriaxone-induced cytopenia is a rare condition. It is known to induce drug-induced immune thrombocytopenia rather than pancytopenia [ 9 ]. A drug-dependent antibody binds to the glycoprotein of the PLT membrane and activates PLT consumption in drug-induced immune thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Severe pancytopenia and coagulopathy discovered during anesthesia after pre-anesthetic evaluation – A report of two cases –

Heo

Kim²,

Lee³

et al. 2023

Anesth Pain Med

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Background: Pre-anesthetic evaluation is an important aspect of perioperative patient management. However, anesthesiologists often encounter challenges during anesthesia due to conditions that are not detected during pre-anesthetic evaluations.Case: Case 1 involved a 74-year-old female patient scheduled for cranioplasty and meningioma excision. Severe pancytopenia was detected during anesthesia. Cranioplasty was only performed, the surgery was terminated, and drug-induced pancytopenia was diagnosed and treated. The pre-anesthetic test results were normal, except for anemia. Case 2 involved a 71-year-old male patient who discovered large ecchymosis during general anesthesia preparation in the operating room for choledochal cyst surgery. Surgery was canceled to evaluate the bleeding tendency, and acquired coagulation factor VIII deficiency was diagnosed and treated. The pre-anesthetic tests were normal, except for prolongation of the activated partial thromboplastin time. Conclusions: Abrupt hematologic and hemostatic changes may occur during anesthesia even though pre-anesthetic evaluation findings are normal.

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“…Some reported shorter time to reach nadir in platelet count in patients with prior exposure to levofloxacin [ 13 ] or even ciprofloxacin [ 14 ]. On the contrary, DITP related to ceftriaxone and associated antibody have been reported, although number of cases are also limited [ 16 17 18 19 ]. In the most recent case report, abrupt-onset severe thrombocytopenia with platelet count of 1,000 /mm 3 occurred after six doses of ceftriaxone [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, DITP related to ceftriaxone and associated antibody have been reported, although number of cases are also limited [ 16 17 18 19 ]. In the most recent case report, abrupt-onset severe thrombocytopenia with platelet count of 1,000 /mm 3 occurred after six doses of ceftriaxone [ 16 ]. Although exposure history to antibiotics of the present case is not certain, previous sensitization to third-generation cephalosporin and/or fluoroquinolones would be possible, since they are commonly prescribed in primary care settings.…”

Section: Discussionmentioning

confidence: 99%

Severe Thrombocytopenia in a Patient with COVID-19

Nham

Jeong

et al. 2020

Infect Chemother

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Coronavirus disease 2019 (COVID-19) outbreak is spreading rapidly all over the world, being a major threat to public health. Since clinical feature of COVID-19 has not been fully evaluated yet, empirical antibacterial agents are frequently combined for the treatment of COVID-19 in addition to antiviral agents, concerning co-existing bacterial pathogens. We experienced a case of severe thrombocytopenia with epistaxis and petechiae, while treating a COVID-19 patient with ceftriaxone, levofloxacin, and lopinavir/ritonavir. The platelet count decreased to 2,000/mm 3 and recovered after discontinuation of the three suspected drugs. In treating a potentially fatal emerging infectious disease, empirical and/or experimental approach would be unavoidable. However, the present case suggests that the possibility of adverse effects caused by polypharmacy should also be carefully considered.

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A Case of Confirmed Ceftriaxone-induced Immune Thrombocytopenia

Cited by 7 publications

References 10 publications

Oral erosions and petechiae during SARS‐CoV‐2 infection

Oral erosions and petechiae during SARS‐CoV‐2 infection

Severe pancytopenia and coagulopathy discovered during anesthesia after pre-anesthetic evaluation – A report of two cases –

Severe Thrombocytopenia in a Patient with COVID-19

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