Ciprofloxacin-induced immune-mediated thrombocytopenia: No cross-reactivity with gemifloxacin

Abstract

SummaryWhat is known and objective: Fluoroquinolone-induced immune-mediated thrombocytopenia is uncommon, and no reports of cross-reactivity among fluoroquinolones exist. Here, we describe a case of ciprofloxacin-induced immune thrombocytopenia with no cross-reactivity with gemifloxacin. Case description:A 77-year-old woman showed profound thrombocytopenia immediately after two ciprofloxacin injections for pneumonia. Platelet counts recovered rapidly after ciprofloxacin discontinuation. She had experienced thrombocytopenia after ciprofloxacin administration 4 years earlier, which was assumed to be ciprofloxacininduced immune-related. Interestingly, no thrombocytopenia occurred following the subsequent exposure to another fluoroquinolone, gemifloxacin. What is new and conclusion:No cross-reactivity occurred between ciprofloxacin and gemifloxacin in this fluoroquinolone-induced immune thrombocytopenia case. K E Y W O R D Sciprofloxacin, cross-reactivity, drug-induced immune thrombocytopenia, gemifloxacin | WHAT IS KNOWN AND OBJECTIVEAlthough drug-induced thrombocytopenia is a common clinical disorder, severe thrombocytopenia (platelet count <50 000/μL) may lead to serious complications. Until recently, only a few cases of fluoroquinolone-induced thrombocytopenia have been reported. 6-13 However, a study has shown a correlation between thrombocytopenia and fluoroquinolone in intensive care unit patients. 14 In addition, some cases of thrombotic thrombocytopenic purpura and DITP associated with fluoroquinolones have been reported. 9,15 The structural similarities between quinine and fluoroquinolones could explain the DITP associated with the latter. 13Nevertheless, no cross-reactivity between fluoroquinolones has been reported in DITP induction. Here, we described a case of ciprofloxacininduced DITP, which was not cross-reactive with gemifloxacin.

Pathogenesis of hemorrhagic disease caused by elephant endotheliotropic herpesvirus (EEHV) in Asian elephants (Elephas maximus)

“…On the other hand, acute onset of thrombocytopenia suggests that it is more likely due to the consumption rather than the destruction of platelets in fatal EEHV-HD cases. More specifically, platelet destruction is found to be predominantly observed in the immune-mediated thrombocytopenia such as drug-induced immune mediated thrombocytopenia and autoimmune diseases 45 – 48 . Collectively and based on this conclusion, therapeutic intervention of acute EEHV-HD cases through the use platelet-rich plasma (PRP) is highly recommended.…”

Quinolone Allergy

“…Immediately after two administered doses of intravenous ciprofloxacin, the patient’s platelet count decreased to 6000/μL from 220,000/μL and the platelet count continued to drop with five days of ciprofloxacin treatment. After the patient was switched to another antibiotic, the platelet count normalized (245,000/μL) during hospitalization and after discharge [56].…”