Ciprofloxacin-Induced Thrombotic Thrombocytopenic Purpura: A Case of Successful Treatment and Review of the Literature

Abstract

A 49-year-old African American woman was admitted to our hospital with abdominal pain, nausea, vomiting, lethargy, and confusion. She was receiving ciprofloxacin for a urinary-tract infection prior to admission. Laboratory examination revealed anemia, thrombocytopenia, elevated lactate dehydrogenase, and serum creatinine. Peripheral smear showed numerous schistocytes, and the patient was diagnosed with thrombotic thrombocytopenic purpura (TTP). Ciprofloxacin was identified as the offending agent. The patient received treatment with steroids and plasmapheresis, which led to rapid clinical recovery. This is the first case to our knowledge of successfully treated ciprofloxacin-induced TTP; previously reported cases had fulminant outcomes. Quinolones are an important part of the antibiotic armamentarium, and this case can raise awareness of the association between quinolones and TTP. A high index of suspicion for detection and early and aggressive management are vitally important for a successful outcome.

Ipilimumab-induced thrombotic thrombocytopenic purpura (TTP)

“…Although it is possible that this patient could have had secondary TTP from oral clindamycin therapy, a literature search failed to demonstrate clindamycin-induced TTP. There have been 2 cases reported of clarithromycin-induced TTP [ 12 ]. Ciprofloxacin has been associated with TTP but our patient was treated with topical ciprofloxacin drops only [ 13 ].…”

Some Pharmacological Studies of Ciproflo

“…The impairment in kidney function markers following ciprofloxacin administration had been documented in Hafiz et al [32] who mentioned that ciprofloxacin treatment was an offending agent causing an increase in serum lactate dehydrogenase and serum creatinine among other adverse effects. Moreover, Shaki et al, [33] reported that ciprofloxacin showed an oxidative damage and inflammation with marked nephrotoxicity, represented by increase in serum BUN and creatinine with histopathological changes.…”

Acute thrombocytopenia suggesting thrombotic microangiopathy

“…Acquired TTP is usually caused by autoantibodies that either inhibit or clear ADAMTS13. Although ciprofloxacin has been reported as a potential cause of drug‐induced TTP, 11 it was continued in our patient, as the temporal onset of thrombocytopenia seemed too soon to implicate it as a biologically plausible trigger. Further, ciprofloxacin was not listed in a systematic review of drug‐induced TTP 12 …”