Rapid Diagnosis of Drug-Induced Thrombocytopenic Purpura

Abstract

Three cases of drug-induced thrombocytopenic purpura are described: One due to quinine, one to quinidine, and the third to diphenylhydantoin (Dilantin). The first 2 recovered promptly following omission of the offending drug, and administration of steroid therapy. The one due to diphenylhydantoin manifested also a severe granulocytopenia, fever and a maculopapular rash, thus suggesting multiple consequences of allergic manifestations referable to the same drug. In all 3 subjects the identity of the thrombocytopenia-inducing drug was established by clot-retraction studies. In order to apply the method during the thrombocytopenic phase of the disease, when the offending drug might still be circulating, and thus when the patient's clot might not retract, the following modification was used: freshly drawn normal blood was admixed with small amounts of the patient's serum and suspected drug, concurrent with appropriate controls. DRUG-INDUCED THROMROCYTOPENIA is a well-established syndrome. The ready availa¬ bility of mixed proprietary compounds containing known sensitizing agents should alert the physician to the possibility of drug sensitización in cases of acute bleeding. Some of these drugs, such as qui¬ nine, are obtainable without prescription, and quinidine, a known sensitizing drug, is being used with greater frequency as our population ages.A report is herewith presented of 3 cases of thrombocytopenic purpura, the first induced by quinine; the second, by quinidine, and the third by diphenylhydantoin ( Dilantin ). The drug which was responsible was established by a simple and rapid test applied within a few hours of admission in the first and third case, and retrospectively in the second. Report of CasesCase 1.-A 20-year-old Para 1 woman was admitted to the Beth Israel Hospital for purpura and bleeding from the lips of 10 hours duration. There was no past or family history of bleeding. Two months prior to admission, the patient was delivered of a normal infant who had no petechiae or bleeding tendency. During the last half of her pregnancy the patient noted that she bruised easily. There were no signs of toxemia. She also noted prolonged men¬ strual flow during the 2 periods following delivery.Thirteen months prior to admission, the patient started taking self-administered quinine sulfate and numerous other medications intermittently for minor complaints. Following the onset of coryza, the patient ingested over a 3-day period, 12 "Cold Tablets Special" containing acetophenetidin (0.045 gm.) and unspecified amounts of quinine sul¬ fate, extracts cascara sagrada, einchonine sulfate, and cap¬ sicum. She also took 0.6 gm. of quinine sulfate on the morning of admission. None of these drugs were prescribed by a physician.Physical examination revealed normal vital signs. The lips and gums were caked with dried blood, and there were recent petechiae on the lower extremities, palate, tonsillar pillars, and tonsils. There was a small conjunctiva] hem¬ orrhage. Aside from a Grade 2 pansystolic precordial mur¬ mur, the rem...

Possible Acute Thrombocytopenia Post Esomeprazole and Hydantoin Coadministration

“…The earliest onset of a phenytoinassociated blood dyscrasia was reported in 1962, where a patient experienced leucopenia, followed by thrombocytopenia, after only 2 days of phenytoin therapy. 1 Most cases of phenytoin-induced thrombocytopenia that have been documented occur approximately a week after phenytoin initiation 7-9,12,13 although some cases are delayed until after years of drug exposure 14,15 (Table 1). The sudden onset of thrombocytopenia in this case report could possibly be evidence of direct platelet toxicity.…”

Akrale Nekrosen nach Therapie mit Chininsulfat wegen Wadenkrämpfen

“…Beobachtet wurden folgende Veränderungen: Thrombozytopenie [2,14,21,25], Niereninsuffizienz [5], granulomatöse Hepatitis [8,15,16], Vaskulitis [8-11, 14, 24], aber auch Granulomatosen, Photosensibilisierung [7,17,22,31], sowohl phototoxisch [30] wie auch photoallergisch [28,32] bedingt, eine Kontaktdermatitis bei einem Arbeiter in einer Chininfabrik [33], Hypoglykämie [18] sowie disseminierte intravasale Gerinnung [5,12]. Beobachtet wurden folgende Veränderungen: Thrombozytopenie [2,14,21,25], Niereninsuffizienz [5], granulomatöse Hepatitis [8,15,16], Vaskulitis [8-11, 14, 24], aber auch Granulomatosen, Photosensibilisierung [7,17,22,31], sowohl phototoxisch [30] wie auch photoallergisch [28,32] bedingt, eine Kontaktdermatitis bei einem Arbeiter in einer Chininfabrik [33], Hypoglykämie [18] sowie disseminierte intravasale Gerinnung [5,12].…”

Diphenylhydantoin-Induced Acute Renal Failure

“…In addition to common dose-dependent and idiosyncratic reactions [1,2], other serious side effects such as exanthema [3], thrombocytopenia [4], agranulocytosis [5], infectious mononucleosis like syndrome [6], hepatitis [7][8][9][10], exfoliative dermatitis [7,8,11] and disseminated intravascularcoagulopathy with purpura fulminans [12] have been reported.…”