Life-Threatening Intrapulmonary Hemorrhage due to Vancomycin-Induced Thrombocytopenia: A Case Report

Abstract

Thrombocytopenia is a rare and sometimes life-threatening complication of Vancomycin. A 52-year-old male patient with acute kidney injury was treated with Vancomycin for ventilator-associated pneumonia. Three days later, his platelets decreased from 172×109/L to 3×109/L over a 36-hour period. The patient developed significant intrapulmonary bleeding leading to profound hypoxemia. Workup was negative for thrombotic thrombocytopenic purpura, disseminated intravascular coagulopathy, atypical hemolytic uremic syndrome, heparin-induced thrombocytopenia, and autoimmune diseases. All recently started medications were discontinued, and the patient was started empirically on methylprednisolone and intravenous immunoglobulin. The patient’s platelets increased, and his airway bleeding stopped within 48 hours; his platelet count returned to normal by 18 days. Vancomycin-dependent anti-platelet antibodies were identified in the patient’s serum by flow cytometry. Thrombocytopenia is an underrecognized complication of Vancomycin that can lead to life-threating bleeding. Stopping Vancomycin may be sufficient to reverse the thrombocytopenia in patients with normal renal function, but more aggressive measures such as steroids, IVIG, and dialysis may be required to stop bleeding and reverse thrombocytopenia in patients with underlying kidney injury who cannot effectively excrete Vancomycin.

Drug-Induced Thrombocytopenia: A Case Involving Vancomycin

“…Although platelet transfusions and steroids were given to the patient in this case, significant improvement in platelet count was not seen until the discontinuation of vancomycin. This finding was compared to other case reports of vancomycin-induced thrombocytopenia, and it was consistently discovered that significant platelet recovery began following vancomycin discontinuation [2,[5][6][7][8][9][10][11][12][13][14]. The normal time frame for platelet counts to return to levels greater than 150x10 3 /μL occurred between 5 and 7 days after vancomycin discontinuation.…”

Vancomycin-Induced Thrombocytopenia in a 35-Year-Old Female With Pneumonia: A Case Report

“…In a study published in the New England Journal of Medicine , platelet-reactive antibodies of IgG, IgM, or both classes with vancomycin dependency were reported in 20% of the samples referred for vancomycin-induced thrombocytopenia testing [ 10 ]. A mean nadir platelet count of 13,600 per cubic millimeter (ranging from 1000 to 60,000) was attained after about eight days (ranging from 1 to 27 days) after vancomycin initiation [ 11 ].…”

“…Her other medications included ondansetron, bupropion, sertraline, tamsulosin, pantoprazole, ergocalciferol, and insulin glargine. Additionally, the patient was placed on a prophylactic dose of enoxaparin while in-patient [ 10 ].…”

Adverse Drug Reactions Caused by Antimicrobials Treatment for Ventilator-Associated Pneumonia

“…Since medication of vancomycin had been stopped, 18 days later, the patient’s platelets returned to normal, this is probably caused by the reduction of vancomycin clearance due to acute renal injury. It is suggested that the slow speed of drug clearance should be considered during medication for patients with renal function injury, which avoid serious consequences caused by drug accumulation ( Abdalhadi et al, 2020 ).…”