Thrombotic Thrombocytopenic Purpura After Prophylactic Cefuroxime Axetil Administered in Relation to a Liposuction Procedure

Abstract

Thrombotic thrombocytopenic purpura (TTP) or Moschcowitz's syndrome is characterized by platelet and von Willebrand factor (vWF) deposition in arterioles and capillaries throughout the body, which results in organ ischemia. The diagnostic pentad characterizing TTP consists of thrombocytopenia, microangiopathic hemolytic anemia (MAHA), fever, neurologic manifestations, and renal insufficiency. In terms of type, TTP can be either idiopathic or secondary. The causes of secondary TTP include pregnancy, infections, pancreatitis, collagen vascular disease, cancer, bone marrow transplantation, and drugs (including cephalosporins). Postoperative TTP has been reported after vascular surgery, renal and liver transplantations, and orthopedic, urologic, and abdominal surgical procedures. Therapeutic plasma exchange (TPE) therapy has reduced the mortality rates, but sometimes patients may have to receive immunosuppressive drugs including vincristine (VCR). This report describes a 42-year-old woman with TTP after prophylactic usage of cefuroxime axetil in relation to a liposuction procedure who was treated successfully with plasma exchange and VCR. The patient fully recovered after 17 TPEs and three doses of VCR. At this writing, her TTP still is in remission after 6 months of follow-up evaluation. To the authors' knowledge, this is the first report in the literature describing a patient with TTP after cefuroxime axetil administered in relation to a surgical procedure who was treated successfully with TPE and VCR.

Thrombotic thrombocytopenic purpura in a postoperative patient taking cephalexin responding to plasmapheresis: A case report and review of cephalosporin‐induced TTP

“…While numerous medications have been documented as triggers for TTP, such as chemotherapeutic and antiplatelet agents, cephalosporins have not been as well described. As cephalosporins are often used in the perioperative period [8], the potential for cephalosporin- [4] Thrombotic thrombocytopenic purpura after prophylactic cefuroxime axetil administered in relation to a liposuction procedure 42 y/o F w/ gross hematuria, headache, and nausea. Took cefuroxime axetil 250 mg daily and Naproxen 550 mg twice daily for 5 days after a liposuction in the lower extremities 10 days prior to the development of TTP.…”

“…TTP has additionally been associated with surgery, presumably due to endothelial damage [5]. To our knowledge, only three cases of cephalosporin induced TTP have been described, with two of these cases occurring with these use of cephalexin [4,6]. We describe a case of TTP occurring in a postoperative patient taking cephalexin, requiring plasmapheresis.…”

“…The use of plasmapheresis improves the survival rate to 80% [3]. A number of drugs have been implicated in the development of TTP, including cyclosporine, tacrolimus, clopidogrel, and quinine [4]. TTP has additionally been associated with surgery, presumably due to endothelial damage [5].…”

Ceftriaxone-Induced Thrombotic Thrombocytopenic Purpura Treated Successfully With Plasmapheresis and Eculizumab: A Rare Case Report

“…A widely used third-generation cephalosporin, ceftriaxone, is often used to treat pneumonia, skin infections, abdominal infections, and urinary tract infections. While previous cases have been reported on cefepime, cephalexin, and cefuroxime, no other ceftriaxone-induced TTP has been published [6][7]. We describe a case of TTP in a patient with a urinary tract infection (UTI) requiring plasmapheresis and eculizumab.…”