Drug-induced Immune Thrombocytopenia

Chong, Beng H.; Choi, Philip Young-Ill; Khachigian, Levon M.; Perdomo, José

doi:10.1016/j.hoc.2013.02.003

Cited by 33 publications

(23 citation statements)

References 80 publications

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“…The incidence of DITP is not well defined; epidemiologic studies performed in the US and Europe showed that approximately 10 persons per million are affected by DITP [15–18]. Despite the low frequency, DITP is important to recognize because of the large number of drugs can be involved and the large number of patients that can be affected [19]. …”

Section: Discussionmentioning

confidence: 99%

“…The former one is caused mostly by myelosuppressive drugs. The latter one can be further divided into three subtypes: nonimmune DITP, immune DITP, and autoimmune DITP [19]. Most DITPs are thought to be caused by the second mechanism, which is mediated by a drug-dependent antibody, and most drugs are thought to cause thrombocytopenia by a drug-dependent immune mechanism.…”

Section: Discussionmentioning

confidence: 99%

“…For most patients, the appropriate treatment is to stop the putative drug, herbal medicine, or food, administering platelet transfusions or other therapies if bleeding is severe [13, 19, 24]. Based on these principles, initial treatment included stopping the use of acyclovir and giving 5 units of donor platelets to for supportive treatment in our case.…”

Section: Discussionmentioning

confidence: 99%

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A rare case report of acyclovir-induced immune thrombocytopenia with tongue hematomas as the first sign, and a literature review

Hong

Wang

2017

BMC Pharmacol Toxicol

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BackgroundAcyclovir has been widely used to treat infections caused by herpes simplex virus (HSV) and varicella zoster virus (VZV). The common adverse effects of this drug include nausea, diarrhea, headache, dizziness and mental changes. The immune thrombocytopenia induced by acyclovir is rare.Case presentationA 67-year-old Chinese male who was given acyclovir 5 mg kg−1 8 hourly intravenously for treatment of VZV infection developed severe thrombocytopenia with fist sign in oral cavity within 10 days of starting using acyclovir. The patient’s condition was improved by stopping using acyclovir and further supportive treatment. The acyclovir-dependent platelet antibody test showed positive results, which implicated acyclovir as the causative agent. The final definitive diagnosis of acyclovir-induced immune thrombocytopenia was established basing on the time correlation between the start of using acyclovir and the onset of symptoms of thrombocytopenia, combining with excluding of other common causes of thrombocytopenia.ConclusionThere have been few reports of acyclovir-induced immune thrombocytopenia. This is the first case report and literature review of acyclovir-induced immune thrombocytopenia, with tongue hematoma as the first sign. Dentists should never overlook this rare adverse effect of acyclovir, as a rapid and appropriate treatment may prevent further severe life-threatening complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A rare case report of acyclovir-induced immune thrombocytopenia with tongue hematomas as the first sign, and a literature review

Hong

Wang

2017

BMC Pharmacol Toxicol

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“…This second pathway is supported by observations that quinine bound to platelets is more resistant to removal in the presence of the drug-dependent antibody, thereby strongly suggesting that the drug may be part of the antibody-GP binding complex. 54…”

Section: Quinine-type Immune Thrombocytopeniamentioning

confidence: 99%

Drug-Induced Thrombocytopenia: Mechanisms and Laboratory Diagnostics

Danese

Montagnana

Favaloro

et al. 2019

Semin Thromb Hemost

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Thrombocytopenia is a condition characterized by a decreased number of platelets in peripheral blood, which can be caused by a myriad of both congenital and acquired disorders. Drug-induced thrombocytopenia (DIT) deserves a special focus since its cumulative incidence can be as high as 10 cases per million population per year, with a prevalence of approximately 25% in critically ill patients. This condition is usually suspected following identification of an acute and severe decrease in platelet count, with values usually < 50 ×109/L, thus potentially exposing patients to an increased risk of developing spontaneous hemorrhages. Conversely, however, some drug-related thrombocytopenias are instead (and perhaps counterintuitively) associated with increased thrombosis risk. Although a vast number of drugs have been implicated in DIT, the underlying pathogenetic mechanisms are essentially bifold, encompassing reduced platelet production due to bone marrow suppression (thus insufficient maturation or inefficient expansion of megakaryocytes, impaired release of platelets, or accelerated platelet apoptosis) or accelerated clearance of platelets from the circulation. This second form of DIT can be sustained by nonimmune, immune-mediated, or autoimmune mechanisms. An early and accurate diagnosis of DIT, which is crucial for reversing an otherwise unfavorable clinical outcome, is essentially based on the complete blood cell count, blood smear analysis, and performance of specific functional or immunochemical tests aimed at demonstrating the presence of antiplatelet antibodies.

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“…12 In another study, most cases of drug-induced anemia were due to ceftriaxone and piperacillin. 13 Drug-induced thrombocytopenia has been described with penicillins, cephalo sporins, sulfonamides, and vancomycin 14 and is a wellrecognized effect of linezolid. The syndrome of drug reaction with eosinophilia and systemic symptoms, a severe and rare adverse reaction, has been reported with minocycline, sulfamethoxazole, and vancomycin.…”

Section: ■ Hematologic and Rheumatologic Effectsmentioning

confidence: 99%

Unusual effects of common antibiotics

Rúiz

Wortmann

2019

CCJM

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A 60-year-old man is admitted for respiratory failure following a massive myocardial infarction. He develops ventilator-associated pneumonia and is treated with cefepime and vancomycin. Three days later, he develops prolonged atypical absence seizures. What caused these seizures? The neurologist thinks it might be the cefepime. Do you agree? Antibiotics are widely used in the United States, with 269 million courses of oral therapy prescribed in 2011. 1 Adverse effects such as rash are well known, but rare effects such as seizure, hypoglycemia, and hypoxemia may not be immediately attributed to these drugs. In this article, we review less-recognized but potentially serious adverse effects of antibiotics commonly prescribed in the United States. We have structured our discussion by organ system for ease of reference. ■ NERVOUS SYSTEM The potential adverse effects of antibiotics on the nervous system range from encephalopathy and seizure to nonconvulsive status epilepticus. Encephalopathy and seizure Encephalopathy has been reported with penicillins, cephalosporins, sulfamethoxazole-trimethoprim, quinolones, and oxazolidinones such as linezolid. 2,3 Seizures are known to occur with penicillins, cephalosporins, carbapenems, and quinolones. 2-4 For cephalosporins, these effects are more common at higher doses, in elderly patients, and in patients with renal impairment. Carbapenems are associated with seizure activity in elderly patients. 2-4

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Drug-induced Immune Thrombocytopenia

Cited by 33 publications

References 80 publications

A rare case report of acyclovir-induced immune thrombocytopenia with tongue hematomas as the first sign, and a literature review

A rare case report of acyclovir-induced immune thrombocytopenia with tongue hematomas as the first sign, and a literature review

Drug-Induced Thrombocytopenia: Mechanisms and Laboratory Diagnostics

Unusual effects of common antibiotics

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