Moxifloxacin (Avelox) Induced Thrombotic Thrombocytopenic Purpura

Abstract

We report a case of a 66-year-old African-American female who presented with complaints of progressively worsening weakness, shortness of breath on minimal exertion, lethargy for the last few days, and short episodes of aphasia lasting 20–30 seconds. Prior to presentation, she was treated with two courses of moxifloxacin for sinusitis. Laboratory examination was remarkable for anemia and thrombocytopenia with elevated lactate dehydrogenase and no evidence of renal failure. Peripheral smear showed numerous schistocytes and she was diagnosed with thrombotic thrombocytopenic purpura. Moxifloxacin was identified as the offending agent. The patient was treated with prednisone and plasmapheresis. To the best of our knowledge, this is the first reported case of thrombotic thrombocytopenic purpura associated with the use of moxifloxacin. Although rare, physicians should be aware of this serious complication associated with its use.

Drug-induced immune thrombocytopenia due to moxifloxacin

“…In addition, this is the first definite causative relationship between moxifloxacin and thrombocytopenia to our knowledge 3. Our patient had two episodes of thrombocytopenia with similar symptoms.…”

“…To our knowledge, this is the second reported case of moxifloxacin causing drug-induced immune thrombocytopenia but the first reported case that caused isolated symptomatic thrombocytopenia 3. The other case involved moxifloxacin causing thrombotic thrombocytopenic purpura.…”

Moxifloxacin related thrombocytopeniae: A case report

“…Although the complication of hemorrhage has been reported in 3 previous cases, no hemorrhage was detected in the current case and thrombocyte replacement was not required (3)(4)(5).…”

“…The most common sideeffects are nausea, diarrhea, headache and dizziness and less frequently, tendinitis, prolongation of QT gap, aplastic anemia, agranulocytosis and pancytopenia (4). However, isolated thrombocytopenia is rare (3)(4)(5). In the current patient, although there were improvements in the infection parameters after the initiation of moxifloxacin therapy, the thrombocytopenia recovered after discontinuing the medication on the consideration of DRT due to the decreased thrombocyte count seen in the laboratory tests.…”

“…Although other quinolone-related thrombocytopenia cases have been reported in literature, there are very few reports of moxifloxacin-related thrombocytopenia (3)(4)(5). In this paper, a case of moxifloxacin-related thrombocytopenia is presented and discussed.…”