Drug Induced Thrombotic Microangiopathy Caused by Levofloxacin

Abstract

Thrombotic microangiopathy is a rare but serious manifestation of a variety of diseases. The key features are microangiopathic haemolysis, thrombocytopaenia, renal dysfunction and neurological symptoms. Here we discuss the case of a previously well male presenting with communityacquired pneumonia who developed thrombotic microangiopathy during admission. This case illustrates the dif culties in the differential diagnosis and reminds us of the importance of the peripheral blood lm in identifying the cause of thrombocytopaenia. One life-threatening cause of thrombotic microangiopathy is thrombotic thrombocytopaenia purpura and when that diagnosis is suspected emergency plasma exchange is essential. Many drugs can cause thrombotic microangiopathy and here we highlight the commonly-prescribed antibiotic levo oxacin as the culprit.Keywords: levofl oxacin, pneumonia, red cell fragments, thrombocytopenia, thrombotic microangiopathy Declaration of interests: No confl ict of interests declaredAbstract Introduction

An Update in Drug-Induced Thrombotic Microangiopathy

“…A new case report implicates again ciprofloxacin in drug-induced TTP which resolved completely with plasma exchange (84). Another report, identified a highly effective and frequently prescribed fluoroquinolone, levofloxacin as a new potential suspect for DITMA (13). This case report described two patients who developed microangiopathic hemolysis and thrombocytopenia following levofloxacin treatment of respiratory tract infections.…”

“…Some examples of drugs in which antibody mediated DITMA has been confirmed with identification of drug-dependent antibodies to platelets or other cells as the pathophysiologic mechanism of TMA are quinine, oxaliplatin, and vancomycin (12). On the other hand, the dose-dependent and cumulative toxicity model seems to fit for opana's abuse, bevacizumab, levofloxacin, alemtuzumab, and interferon's cases of DITMA (9,(13)(14)(15). It is important to exclude any other diagnosis before attributing TMA to a drug.…”

Common and Rare Hematological Manifestations and Adverse Drug Events during Treatment of Active TB: A State of Art

“…Few cases of hematologic reaction due to levofloxacin were reported [ 73 ]. Thrombocytopenia, pancytopenia, microangiopathy and hemolytic anemia are adverse events related to levofloxacin administration [ 73 , 74 , 75 ].…”

Late onset of hemolytic uremic syndrome after the appearance of prodromal gastrointestinal tract symptoms

“…patients. 17 In addition, reports of autoimmune hemolytic anemia and thrombotic microangiopathy caused by levofloxacin are extremely rare, [18][19][20] with all of them involving autoimmune hemolytic anemia and thrombotic microangiopathy during levofloxacin treatment. [18][19][20] We believe that levofloxacin administration was not related to the HUS in this case.…”