Fulminant drug-induced immune thrombocytopenia in polycystic kidney disease with cyst infection
Abstract
A 65-year-old man with polycystic kidney disease who had undergone living-donor kidney transplantation presented with fever and left flank pain and was diagnosed with renal cyst infection. Combination antimicrobial therapy with levofloxacin, clindamycin, meropenem, and teicoplanin was initiated. His platelet count was 257,000/µL on day 5; however, it abruptly declined overnight to below the lower limit of detection (< 2,000/µL). He subsequently developed a massive retroperitoneal hematoma, presumably due to hemorrhage from the infected renal cyst, and required emergency selective arterial embolization. Drug-induced immune thrombocytopenia was strongly suspected, and all recently initiated medications were discontinued. He was treated with high-dose intravenous dexamethasone and intravenous immunoglobulin, leading to a transient recovery of the platelet count. However, thrombocytopenia recurred during prednisolone tapering. Although drug-dependent platelet-reactive antibodies were not detected in the patient's serum, teicoplanin was considered a plausible causative agent based on pharmacokinetic considerations and previous reports; however, the causative drug could not be definitively identified. This case illustrates fulminant thrombocytopenia highly suggestive of drug-induced immune thrombocytopenia in which the platelet count fell to an undetectable level overnight. In patients receiving multiple drugs, clinicians should remain vigilant for drug-induced immune…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Ferulic acid regulates the AKT/GSK-3β/CRMP-2 signaling pathway in a middle cerebral artery occlusion animal model
- Novel Pharmacokinetic/Pharmacodynamic Parameters Quantify the Exposure–Effect Relationship of Levofloxacin against Fluoroquinolone-Resistant Escherichia coli
- Photochemical behavior of levofloxacin
- Correlation Between Dissolution Profiles of Salt-Form Drugs in Biorelevant Bicarbonate Buffer and Oral Drug Absorption: Importance of Dose/ Fluid Volume Ratio
- Evaluation of the synergistic potential and mechanisms of action for de novo designed cationic antimicrobial peptides
- Synthesis of [11C]levofloxacin
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.