A Case of Vancomycin-Induced Immune Thrombocytopenia

MacDougall, Kira; Parylo, Sara; Sokoloff, Alisa

doi:10.7759/cureus.7940

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…Although platelet transfusions and steroids were given to the patient in this case, significant improvement in platelet count was not seen until the discontinuation of vancomycin. This finding was compared to other case reports of vancomycin-induced thrombocytopenia, and it was consistently discovered that significant platelet recovery began following vancomycin discontinuation [ 2 , 5 - 14 ]. The normal time frame for platelet counts to return to levels greater than 150x10 3 /μL occurred between 5 and 7 days after vancomycin discontinuation.…”

Section: Discussionmentioning

confidence: 78%

Drug-Induced Thrombocytopenia: A Case Involving Vancomycin

Barnecet Pérez,

Niehues,

Hicks

et al. 2023

Cureus

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Drug-induced thrombocytopenia (DIT) is a rare adverse effect that occurs when administering various medications. The medications associated with this possible adverse effect include heparin, penicillin, furosemide, vancomycin, non-steroidal anti-inflammatory drugs, ranitidine, and many others. DIT causes a rapid decrease in platelet counts after drug administration and typically resolves once the offending agent has been discontinued. The induced thrombocytopenia increases the bleeding risk and possibility of adverse effects throughout a hospital course. In this case report, we look at the presenting symptoms and treatment course of an interesting case of DIT that occurred following the administration of vancomycin.

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Section: Discussionmentioning

confidence: 78%

Drug-Induced Thrombocytopenia: A Case Involving Vancomycin

Barnecet Pérez,

Niehues,

Hicks

et al. 2023

Cureus

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“…Platelets aggregate at the site of a bleed and bind to von Willebrand factor and fibrinogen to form a thrombus to inhibit bleeding. A reduction in platelet count inhibits this pivotal mechanism of thrombosis [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Vancomycin-Induced Thrombocytopenia in a 35-Year-Old Female With Pneumonia: A Case Report

Gyabaah,

Trivedi,

Prakash

et al. 2023

Cureus

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Vancomycin is one of the most empirically used antibiotics in severely ill patients in hospitalized settings. Vancomycin-induced thrombocytopenia (VITP) is a rare and potentially life-threatening complication that requires immediate recognition. Platelet destruction is largely immune-mediated and results in a precipitous drop in the platelet count over a short period of time. Most cases of VITP are drug-dependent, as discontinuation of the offending agent frequently results in a timely return to baseline to pre-exposure platelet levels. Here, we present a case of severe vancomycin-induced thrombocytopenia in a 35-year-old female with a history of multiple comorbidities who presented with pneumonia. She was undergoing treatment with vancomycin and piperacillin-tazobactam and developed thrombocytopenia within 24 hours of hospitalization. The patient was on a loading dose of 1250 mg intravenous vancomycin every 24 hours and piperacillin-tazobactam 3.375 g intravenously every six hours for presumed community-acquired pneumonia. Her other medications included ondansetron, bupropion, sertraline, tamsulosin, pantoprazole, ergocalciferol, and insulin glargine. Additionally, the patient was placed on a prophylactic dose of enoxaparin while in-patient. The patient’s thrombocytopenia resolved with discontinuation of vancomycin. Clinicians should be well-informed about which medications can trigger thrombocytopenia whenever starting a medication in such cases.

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“…The early diagnosis of VIT is quite difficult due to many suspected causes, such as severe infection, disseminated intravascular coagulation, heparin, and other medications. The correct diagnosis can be masked by the simultaneous administration of medications, which can cause drug-induced immune thrombocytopenia[ 14 ] or a complicating disease, such as primary idiopathic thrombocytopenic purpura or chronic hepatitis C[ 15 ]. Therefore, the early recognition of VIT was of key importance for the following treatment.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin-induced thrombocytopenia in endocarditis: A case report and review of literature

Guleng

Guo

2021

WJCC

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BACKGROUND Thrombocytopenia is a serious complication in the medical practice of numerous drugs. Vancomycin is frequently used for the prophylaxis and treatment of suspected or identified methicillin-resistant positive infections. Several cases with vancomycin-induced thrombocytopenia (VIT) have been reported. However, these have rarely been extensively reviewed. The present report describes a case of VIT in endocarditis, and reviews all VIT cases reported in the literature. CASE SUMMARY A 26-year-old male diagnosed with infective endocarditis was admitted. The patient was treated with multiple drugs, including vancomycin, which was initially intravenously given at 1000 mg every 12 h and subsequently at 500 mg every 8 h on day 3. On day 11, the platelet count decreased to 51 × 10 9 /L, vancomycin was switched to 500 mg every 12 h, and platelet transfusion was given. On day 17, the platelet count dropped to 27 × 10 9 /L, and platelet transfusion was administered again. On day 23, vancomycin was adjusted to 500 mg every 8 h as the trough concentration dropped to the minimum effective concentration. On day 33, the platelet count declined to approximately 40 × 10 9 /L. After platelet transfusion, the platelet count rebounded to 90 × 10 9 /L on day 35 but dropped again to 42 × 10 9 /L on day 43. Based on the time-to-platelet count curve and Naranjo’s Adverse Drug Reaction Probability Scale score, VIT was suspected. After vancomycin discontinuation and platelet transfusion, the platelet count gradually normalized. CONCLUSION The diagnosis of VIT can be achieved through the time-to-platelet count curve and Naranjo’s Adverse Drug Reaction Probability Scale score. The platelet count cannot be normalized simply by platelet transfusion alone, and vancomycin discontinuation is essential.

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A Case of Vancomycin-Induced Immune Thrombocytopenia

Cited by 6 publications

References 12 publications

Drug-Induced Thrombocytopenia: A Case Involving Vancomycin

Drug-Induced Thrombocytopenia: A Case Involving Vancomycin

Vancomycin-Induced Thrombocytopenia in a 35-Year-Old Female With Pneumonia: A Case Report

Vancomycin-induced thrombocytopenia in endocarditis: A case report and review of literature

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