Patel S, Levin-Epstein R, Kobashigawa J
Tufts University School of Medicine, Boston, Massachusetts, USA.
Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Transplant Proc. 2017 Sep;49(7):1672-1674. doi: 10.1016/j.transproceed.2017.02.043. Epub 2017 Aug 4.
The present study reports a case of piperacillin-induced thrombocytopenia in a dual heart and kidney transplant patient on January 28, 2016 (taking mycophenolate mofetil and tacrolimus). Before the transplant, the patient was treated with Zosyn twice, with no reports of thrombocytopenia or allergy. However, he was diagnosed with heparin-induced thrombocytopenia and vancomycin allergy during each of those hospitalizations, respectively. Eight months after the transplant, the patient presented with infectious symptoms and was started on Zosyn.
One day after starting Zosyn, the patient experienced a drop in platelet count from 6,000/μL from 216,000/μL. Platelets decreased as low as 1 on day 3 of hospitalization. Administration of mycophenolate mofetil, tacrolimus, Bactrim, vancomycin, Zosyn, ranitidine, and Rivaroxaban were discontinued. Platelet counts stabilized the day after Zosyn was discontinued and slowly increased after the patient was treated with 2 doses of intravenous immunoglobulin, 4 units of platelets, and a tapered dose of prednisone.
The patient was initially diagnosed with vancomycin-induced thrombocytopenia but then tested positive for antibodies to piperacillin and negative for antibodies to vancomycin and tazobactam. The patient was discharged with a diagnosis of piperacillin-induced thrombocytopenia. This case report presents a case of piperacillin-induced thrombocytopenia, previously misdiagnosed as vancomycin-induced thrombocytopenia and heparin-induced thrombocytopenia.
本研究报告了一例2016年1月28日接受心脏和肾脏双器官移植的患者发生哌拉西林诱导的血小板减少症的病例（患者正在服用霉酚酸酯和他克莫司）。移植前，该患者曾接受过两次哌拉西林/他唑巴坦治疗，未出现血小板减少症或过敏反应的报告。然而，在每次住院期间，他分别被诊断为肝素诱导的血小板减少症和万古霉素过敏。移植八个月后，患者出现感染症状并开始使用哌拉西林/他唑巴坦。
开始使用哌拉西林/他唑巴坦一天后，患者的血小板计数从216,000/μL降至6,000/μL。住院第3天时血小板计数降至低至1/μL。停用了霉酚酸酯、他克莫司、复方新诺明、万古霉素、哌拉西林/他唑巴坦、雷尼替丁和利伐沙班。停用哌拉西林/他唑巴坦后的第二天血小板计数稳定，在患者接受2剂静脉注射免疫球蛋白、4单位血小板和逐渐减量的泼尼松治疗后，血小板计数缓慢上升。
该患者最初被诊断为万古霉素诱导的血小板减少症，但随后哌拉西林抗体检测呈阳性，万古霉素和他唑巴坦抗体检测呈阴性。患者出院时诊断为哌拉西林诱导的血小板减少症。本病例报告展示了一例先前被误诊为万古霉素诱导的血小板减少症和肝素诱导的血小板减少症的哌拉西林诱导的血小板减少症病例。
