Vancomycin
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Thrombocytopenia: case report A 71-year-old man developed thrombocytopenia during treatment with vancomycin for osteomyelitis. The man, who had methicillin-resistant Staphylococcus aureus sacral/coccygeal osteomyelitis secondary to a pressure ulcer, started receiving vancomycin [initial route and dosage not stated]. Twenty four hours after the initiation of vancomycin, his platelet count decreased from 182 000 /mm3 to 860 00 /mm3. Laboratory test result consistent with thrombocytopenia secondary to vancomycin. The man’s treatment with vancomycin was discontinued. Seven days after the discontinuation of vancomycin, his platelet count normalised. Five months later, the man was admitted and again received IV vancomycin 1.5g every 12 hours. One day after the initiation of vancomycin, laboratory test revealed platelet count of 3000 /mm3, indicated severe thrombocytopenia. He also developed gastrointestinal bleed with symptoms of easy bruising and lower-extremity petechiae. Subsequently, the gastrointestinal bleed was successfully treated with packed RBC transfusion. Laboratory tests ruled out sepsis, disseminated intravascular coagulation, and heparin-induced thrombocytopenia. He was diagnosed with vancomycininduced thrombocytopenia. On day 3 of therapy, vancomycin was discontinued. He received platelet transfusion; however, the condition persisted. Then, he was started on treatment with immunoglobulin and dexamethasone, which was continued for 2 days. His platelet count began to improve 4 days after discontinuation of vancomycin. Eight days after the discontinuation of vancomycin, thrombocytopenia resolved completely. Author comment: "In our case, the Naranjo Adverse Drug Reaction Probability Scale score was 9, indicating vancomycin as the definite cause of thrombocytopenia." "We report a case of rapid-onset, severe vancomycin-induced thrombocytopenia (VIT) that occurred with reexposure and resolved with discontinuation of vancomycin." Getz TM, et al. Rapid-Onset Vancomycin-Induced Thrombocytopenia With Reexposure. Annals of Pharmacotherapy 53: 1259-1261, No. 12, 1 Dec 2019. Available from: URL: http://doi.org/10.1177/1060028019867433 803435772 USA
0114-9954/19/1780-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 23 Nov 2019 No. 1780
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