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Anaphylactic reaction and thrombocytopenia: case report A 50-year-old man developed anaphylactic reaction to ceftriaxone. Additionally, he developed thrombocytopenia during treatment with lansoprazole [not all indications, dosages, durations of treatments to reactions onsets and outcomes stated]. The man had a history of type II diabetes mellitus, hypertension and coronary artery disease. He was admitted for elective ureteroscopy under general anesthesia for ureteric stone. His medications included aspirin, clopidogrel, metformin, rosuvastatin, levofloxacin and pantoprazole. Prior to the procedure, his aspirin and clopidogrel were held to minimize the bleeding risk. At admission, his BP was 100/62mm Hg, respiratory rate was 20 bpm, HR was 64 bpm and oxygen saturation was 99% on room air. Prior to the anaesthesia induction, he received IV ceftriaxone 2g. However, he developed hypotension, facial swelling and bradycardia. This progressed to pulseless electrical activity requiring cardiopulmonary resuscitation. He was intubated. Although the cause of cardiac arrest was not clearly identified, it was thought to be an anaphylactic reaction to ceftriaxone. The man eventually improved and was shifted to the ICU. During resuscitation and ICU admission, he received treatment with various medications. Aspirin and clopidogrel were restarted. Rosuvastatin and metformin were held. He was started on lansoprazole 30mg once daily by nasogastric route for stress ulcer prophylaxis, along with heparin for venous thromboembolism prophylaxis. Subsequently, he was extubated. He underwent haemodialysis for acute kidney injury. His kidney function improved. On hospital day 2, he developed abdominal pain and diarrhoea. A CT scan of the chest and abdomen showed multiple rib fractures and diffuse bowel oedema. On day 5 of lansoprazole initiation, his platelets dropped progressively. Heparin was suspended and heparininduced thrombocytopenia was ruled out. Hence, a diagnosis of lansoprazole-induced thrombocytopenia was suspected. His lansoprazole was switched to ranitidine, and heparin was reinitiated. Within 3 days, his platelet count recovered. Later, he developed a urinary tract infection and was treated with aztreonam. After two days, extended spectrum beta-lactamase Escherichia coli observed upon urine and blood cultures. Therefore, aztreonam was changed to ertapenem. On hospital day 14, he developed thrombocytosis, which was thought to have reactived secondary to the infection. Concurrently, his platelet count continued to increase gradually. He was initiated on oral lansoprazole 30mg daily due to suspected upper GI bleeding on hospital day 18. However, after 5 days of the lansoprazole initiation, his platelet count dropped again. On hospital day 20, he started to pass fresh blood with stools and received 2 units of packed red blood cells. Lansoprazole was discontinued. His platelet counts improved. On hospital day 25, he was diagnosed with inflammatory bowel disease. Therefore, mesalazine was initiated. Consequently, his diarrhoea