Vancomycin
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Thrombocytopenia: case report A 60-year-old man who had undergone right shoulder rotator cuff repair developed thrombocytopenia during treatment with vancomycin for postoperative Staphylococcus aureus and Enterococcus spp infections. The patient was treated with IV vancomycin 1500mg every 12 hours and oral ciprofloxacin. He was also receiving heparin flushes to maintain patency of the peripherally inserted catheter. In the third week after commencing treatment with vancomycin, he presented with a platelet count of 6 x 103/mm3 and was admitted for further work-up. Examination revealed extensive petechial haemorrhages on both lower limbs and repeat platelet count was 9 x 103/mm3. Investigations ruled out diagnoses of disseminated intravascular coagulopathy and heparininduced thrombocytopenia. Vancomycin-induced antiplatelet antibody tests revealed IgG-positive antibodies in the presence of vancomycin. Vancomycin was discontinued on the first day after hospital admission. The patient underwent platelet transfusion. By the third day, his platelet count had increased to 271 x 103/mm3 and he was discharged on tigecycline. Platelet counts remained normal over 2 weeks of follow-up. Author comment: "The diagnosis of drug-induced thrombocytopenia is often overlooked. However, it is a potentially life-threatening condition, and testing with drugdependent antibodies, such as vancomycin-induced plateletreactive antibodies, can be helpful in identifying the cause of thrombocytopenia in patients receiving vancomycin." Shah RA, et al. Vancomycin-induced thrombocytopenia in a 60-year-old man: A case report. Journal of Medical Case Reports 3: Jan 2009. Available from: URL: 803013446 http://dx.doi.org/10.4076/1752-1947-3-7290 - USA
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Reactions 8 May 2010 No. 1300
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