a Oncology Center , King Khalid University Hospital, King Saud University , Riyadh , Saudi Arabia.
b Internal Medicine Program , King Saud University , Riyadh , Saudi Arabia.
Platelets. 2018 Sep;29(6):628-631. doi: 10.1080/09537104.2018.1468025. Epub 2018 Jun 4.
Pipercillin-tazobactam is a frequently used antibiotic that has a broad spectrum of antibacterial activity. The development of severe thrombocytopenia following the use of piperacillin-tazobactam is unusual. Several mechanisms have been proposed for the pathogenesis of thrombocytopenia in this setting which include immune and non-immune causes. Multiple case reports have shown the ability of piperacillin-tazobactam to cause drug-induced immune thrombocytopenia, likely through formation of antibodies that recognize platelets in the presence of soluble piperacillin. However, severe and rapid development of thrombocytopenia that occurs in association with reexposure to piperacillin-tazobactam has not been clearly demonstrated in the literature. We present two cases in whom severe and rapid development of thrombocytopenia has occurred subsequent to administration of piperacillin-tazobactam with a prior history of recent exposure to the drug. In both cases, thrombocytopenia improved immediately and dramatically following withdrawal of piperacillin-tazobactam with initiation of steroids and intravenous immunoglubulins, suggesting and immune related drug-induced thrombocytopenia.
哌拉西林他唑巴坦是一种常用的抗生素，具有广谱的抗菌活性。使用哌拉西林他唑巴坦后出现严重血小板减少症并不常见。该情况下血小板减少症的发病机制提出了几种机制，包括免疫和非免疫原因。多项病例报告表明，哌拉西林他唑巴坦能够引起药物诱导的免疫性血小板减少症，可能是通过在存在可溶性哌拉西林的情况下形成识别血小板的抗体。然而，文献中并未明确证明与再次暴露于哌拉西林他唑巴坦相关的严重和快速发展的血小板减少症。我们提出了两例先前曾接触过该药物的患者在使用哌拉西林他唑巴坦后发生严重和快速发展的血小板减少症的病例。在这两种情况下，停用哌拉西林他唑巴坦并开始使用类固醇和静脉注射免疫球蛋白后，血小板减少症立即显著改善，提示与免疫相关的药物诱导性血小板减少症。
