• PDF / 171,196 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 30 Downloads / 148 Views

DOWNLOAD

REPORT

---

1 S

Drug eruption, tricytopenia with thrombocytopenia and off-label use: case report A 79-year-old woman developed drug eruption during anti-infective treatment with vancomycin. Later, she developed tricytopenia with marked thrombocytopenia during off-label anti-infective therapy with linezolid for spondylodiscitis [not all dosages and routes stated]. The woman, who had confirmed endocarditis with Enterococcus faecalis, had been suffering from persistent back pain, and she was admitted to the neurology unit of a hospital in Germany. She was diagnosed with spondylodiscitis with bilateral psoas abscesses. She had a complex medical history and had been receiving various concomitant medications. She then started receiving anti-infective treatment with ampicillin and gentamicin for endocarditis. Following final identification of Enterococcus faecalis with high-level aminoglycoside resistance, the treatment was switched according to the antibiogram to ampicillin and ceftriaxone, which was also suitable for the newly diagnosed spondylodiscitis in a scheduled duration of therapy of 6 weeks. However, it was noted that an extension of antibiotic therapy to 8–12 weeks was required depending on the clinical course due to the non-remediated abscesses. After 25 days, she developed fever flare-ups several times, and she experienced an increase in the abscesses in the lumbar spine. Also, multi-resistant coagulase-negative Staphylococci were detected. Therefore, the anti-infective therapy was switched to vancomycin on day 29 to cover all the identified bacteria due to the clinical deterioration. However, renal function markedly worsened after 1 week. Therefore, vancomycin was continued at a reduced dose of 750mg every 48 hours. On day 60, she developed a drug eruption along with severe itching, fever, chills and swollen upper lip, and vancomycin was suspected to have triggered the drug eruption. Therefore, the woman was treated with prednisolone and clemastine [clemastin], and vancomycin was switched to off-label oral linezolid 600mg twice daily on day 63. Subsequently, a slow resolution of the drug eruption was observed. While she exhibited a good clinical course, on day 83 (3 weeks following initiation of linezolid), she developed tricytopenia with clinically relevant decrease in platelets (thrombocytopenia) and white blood cells. Also, she had massively elevated linezolid concentration. It was noted that she developed side-effects of tricytopenia with thrombocytopenia due to linezolid. Therefore, linezolid was held, and the platelets in the blood increased markedly within 5 days. Then, after 7 days, the woman’s off-label oral linezolid was re-initiated at a reduced dose of 300mg every 12 hours. Linezolid concentrations were monitored. On day 104, an elevated linezolid level was noted, and the platelet count remained within normal range. She continued to receive off-label linezolid with adequate clinical response and good tolerability until the scheduled end of therapy. Blassmann U, et al. Thrombocytopenia due to linezolid - Dis