Acute Severe Thrombocytopenia Event Associated with Trimethoprim/Sulfamethoxazole Use

Abstract

Objective: To report a case of life-threatening thrombocytopenia associated with the use of trimethoprim/sulfamethoxazole (TMP/SMX) therapy. Report of the case: 50-year-old woman with no significant past medical history who presented with one day of petechial rash on her arms, chest and legs. Patient reports that she had just completed a 7- day course of TMP/SMX (1-double strength tablet twice a day) for uncomplicated UTI by her PMD. On admission, the patient was hemodynamically stable, and complete blood cell count revealed a platelet count of 2000/uL. TMP/SMX was believed to be the most likely cause of thrombocytopenia. After discontinuation of TMP/SMX and treatment with 2 units of platelets, 1gm intravenous immunoglobulin (IVIG) and oral dexamethasone, repeat CBC showed a stable platelet count of 90,000/uL. Patient was successfully discharged on hospital day 3 with outpatient follow up with the hematology clinic for further monitoring. Conclusion and Discussion: Differential diagnosis of severe thrombocytopenia include drug induced thrombocytopenia (DITP), thrombotic thrombocytopenic purpura (TTP), post transfusion purpura (PTP), immune thrombocytopenic purpura (ITP), heparin induced thrombocytopenia (HIT), or catastrophic antiphospholipid antibody syndrome (APS). Drug-dependent antibodies are an unusual class of antibodies that bind firmly to specific epitopes on platelet surface glycoproteins only in the presence of the sensitizing drugs. DITP typically has an abrupt onset of severe thrombocytopenia, usually less than 20,000/uL. Thrombocytopenia usually begins to recover within 1-2 days after the offending drug is discontinued and platelet levels usually normalize within one week as demonstrated in our case report. Pharmacological treatment can include platelet transfusions in case of severe, overt bleeding, corticosteroids or IVIG administration. In most cases, however, discontinuation of the offending drug is sufficient.

Prevalence of drug induced thrombocytopenia in five cities of India: A cross sectional descriptive study

“…The present study designed to distribution of the prevalence of the drug induced thrombocytopenia found that the prevalence is 4.7% in selected cities, these findings were similar to the study. [8][9][10][11] the study witnessed that out of 261 samples 165 (63.21%) were males and 96 (58.18%) were females these finding were similar to study [12][13][14][15][16] and the study also found that the age of drug induced thrombocytopenia is similar in all age groups these findings were similar to the study. 17,18…”

Development and Validation of a Nomogram for Predicting Drug-induced thrombocytopenia in Hospitalized Patients: A Case‒Control Study Based on Propensity-Score Matching

“…DITP is an adverse drug reaction (ADR) and a signi cantly underrecognized clinical problem. In the event of DITP, the platelet count is usually below 100×10 9 /L; therefore, DITP can often lead to abrupt and severe bleeding complications and even death [2,3]. DITP urgently requires further attention since its cumulative incidence is 10 cases per million population per year, with a 25% prevalence in critically ill patients [4].…”

Detection of Drug-Induced Thrombocytopenia Signals in Children Using Routine Electronic Medical Records

“…Drug-induced thrombocytopenia (DITP) is an adverse reaction and a significantly under-recognized clinical problem. The platelet count is usually less than 100×10 9 /L; therefore, DITP can often lead to abrupt and severe bleeding complications and even death ( Vayne et al, 2020 ; Doodnauth et al, 2021 ). DITP deserves special attention since its cumulative incidence is 10 cases per million population per year, with a prevalence as high as 25% in critically ill patients ( Danese et al, 2020 ).…”