A Rare Case of Rapid Onset Thrombocytopenia Induced by Piperacillin/Tazobactam in a Liver Transplant Recipient

AlSardi, Mais; Ali, Hala F; Handoo, Fayaz A.; Al-Jawad, Mohammed S.

doi:10.7759/cureus.18000

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…Previous reports described the use of other beta-lactam antibiotics, such as carbapenems, 15 – 18 cefepime, 3 , 19 , 20 cefoperazone, 15 and aztreonam, 16 in patients with thrombocytopenia induced by piperacillin–tazobactam. In our case, the patient did not tolerate cefoperazone–sulbactam despite successful treatment with meropenem and cefotiam.…”

Section: Discussionmentioning

confidence: 99%

Cross-reactivity between piperacillin–tazobactam and cefoperazone–sulbactam in drug-induced immune thrombocytopenia

Huang

Wan

et al. 2023

J Int Med Res

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Beta-lactam antibiotics commonly cause immune thrombocytopenia. Cross-reactivity in patients with drug-induced immune thrombocytopenia has rarely been reported. In this study, we describe the case of a 79-year-old man who developed thrombocytopenia after receiving piperacillin–tazobactam for an acute exacerbation of chronic obstructive pulmonary disease, and he was successfully treated with meropenem and cefotiam. However, thrombocytopenia recurred after cefoperazone–sulbactam administration. This indicated that cross-reactivity of platelet-specific antibodies occurred between piperacillin–tazobactam and cefoperazone–sulbactam. However, the responsible drug structures remain unknown, requiring further investigation. Likewise, chemical structure similarities among beta-lactam antibiotics must be examined to determine the risk of immune thrombocytopenia in the clinical setting.

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Section: Discussionmentioning

confidence: 99%

Cross-reactivity between piperacillin–tazobactam and cefoperazone–sulbactam in drug-induced immune thrombocytopenia

Huang

Wan

et al. 2023

J Int Med Res

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“…Platelet transfusions, intravenous immunoglobulin (IVIG), or steroids are also options to help improve platelet counts in the setting of persistent thrombocytopenia or bleeding [10]. Previous cases of drug-induced thrombocytopenia were successfully treated with combinations of these proposed treatments as well as no intervention [12].…”

Section: Discussionmentioning

confidence: 99%

Piperacillin-Tazobactam Induced Rapid Severe Thrombocytopenia Without Known Exposure

Bhaskarla¹,

Gorecki²,

Ghouse³

2022

Cureus

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Thrombocytopenia is one of the commonly encountered laboratory abnormalities in the inpatient setting. The process of excluding life-threatening causes can be daunting and may result in overlooking iatrogenic sources such as medications. Antibiotics are known culprits; however, there are limited reports of rapid and severe onset thrombocytopenia following piperacillin-tazobactam (TZP) that were frequently observed in critically ill or immunocompromised patients with previous exposure to the antibiotic. This case describes a patient being treated for a soft tissue infection with vancomycin and TZP. Initiation of antimicrobial therapy resulted in severe thrombocytopenia and a platelet nadir of approximately 4,000 within 24 hours of the first doses. Thrombocytopenia resolved within three days of TZP withdrawal. To the best of our knowledge, there have not been any cases described of rapid drug-induced thrombocytopenia without previous exposure to the medication. Medications should always be reviewed when evaluating a patient with rapid and severe thrombocytopenia, which can obviate the need for unnecessary invasive or non-invasive treatments.

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“…In clinical practice, piperacillin-tazobactam is commonly used as a broad-spectrum antibiotic. Different lifethreatening adverse drug reactions (ADRs) like thrombocytopenia in liver-transplant patients, drug-induced hemolytic anemia in neonates, and Steven Johnson syndrome have been reported with long-term use of piperacillin-tazobactam [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Piperacillin-Tazobactam-Induced Urticaria and Angioedema: A Case Report With Literature Review

Pandya,

Patel,

Sojitra

et al. 2024

Cureus

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Drug-induced urticaria and angioedema cases are typically reversible upon discontinuation and can be triggered by antibiotics, angiotensin-converting enzyme inhibitors, or nonsteroidal anti-inflammatory drugs. Piperacillin-tazobactam, a common broad-spectrum antimicrobial, has been linked to severe adverse reactions, such as thrombocytopenia, hemolytic anemia, and Steven Johnson syndrome in some cases. A 35year-old male presented to the emergency department with fever, cough, and acute breathlessness, complicating his ongoing treatment for pulmonary tuberculosis with bedaquiline and delamanid. He was admitted and received supportive care. On the third day of intravenous piperacillin-tazobactam, he developed drug-induced urticaria and angioedema, which resolved upon discontinuing the drug. Piperacillin/tazobactam-induced hypersensitivity reaction is an immunologic and IgE-mediated immediate reaction. IgE-mediated immediate reactions to three major phenotypes of allergic patients with confirmed to piperacillin/tazobactam are either (1) sensitized to the β-lactam ring or (2) sensitized to the lateral chain of aminopenicillins or (3) selective to piperacillin/tazobactam alone. A skin patch test is advised, or prescribed to avoid hypersensitivity reactions due to piperacillin/tazobactam. This case underscores the challenges of non-adherence to anti-tubercular therapy, leading to drug resistance and prolonged, costly, and sometimes intolerable treatments. Regular patient follow-up, counseling, monitoring, and healthcare provider involvement are essential to enhance treatment adherence. Adverse drug reactions must be promptly reported and managed, and patient-centric approaches are crucial. Digital patient records and standardized data collection are recommended for program evaluation and global policy development. Causality assessment for piperacillin-tazobactam was diagnosed as the probable cause of drug-induced urticaria and angioedema. This case highlights the importance of adherence to tuberculosis treatment to prevent drug resistance. Overall, patient-centered care, monitoring adverse events of drug added, and better data collection are crucial for successful tuberculosis management.

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A Rare Case of Rapid Onset Thrombocytopenia Induced by Piperacillin/Tazobactam in a Liver Transplant Recipient

Abstract: Al-Sardi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Cited by 5 publications

References 15 publications

Cross-reactivity between piperacillin–tazobactam and cefoperazone–sulbactam in drug-induced immune thrombocytopenia

Cross-reactivity between piperacillin–tazobactam and cefoperazone–sulbactam in drug-induced immune thrombocytopenia

Piperacillin-Tazobactam Induced Rapid Severe Thrombocytopenia Without Known Exposure

Piperacillin-Tazobactam-Induced Urticaria and Angioedema: A Case Report With Literature Review

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