Vancomycin-induced thrombocytopenia: a challenge and rechallenge.
OBJECTIVE: To report a case of thrombocytopenia apparently associated with vancomycin use. CASE SUMMARY: A 58-year-old white man was admitted to the hospital with chronic osteomyelitis of the foot due to methicillin-resistant Staphylococcus aureus that later spread hematogenously to the cervical vertebrae. During the first course of therapy with vancomycin, his platelet count decreased from 397 x 10(3)/mm3 to 22 x 10(3)/mm3. After discontinuation of the drug, it increased to 310 x 10(3)/mm3. During the second course of vancomycin, the platelet count decreased to 77 x 10(3)/mm3, and increased to 404 x 10(3)/mm3 after discontinuation of the drug. DISCUSSION: Vancomycin has been reported as a rare cause of thrombocytopenia. Thrombocytopenia can occur as an adverse drug reaction by the following three mechanisms: direct toxic effect, drug absorption (hapten) formation, and an "innocent bystander" immune response. CONCLUSIONS: We suspect that the thrombocytopenia in this patient, which involved an increased number of megakaryocytes in the bone marrow, was due to vancomycin.[1]References
- Vancomycin-induced thrombocytopenia: a challenge and rechallenge. Howard, C.E., Adams, L.A., Admire, J.L., Chu, M.A., Alred, G.L. The Annals of pharmacotherapy. (1997) [Pubmed]
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