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Thrombotic thrombocytopenia purpura caused by piperacillin successfully treated with plasma infusion
Y Yata1, M Miyagiwa, S Inatsuchi
1Department of Internal Medicine, Toyama Red Cross Hospital, Japan. yyata@duke.edu
Abstract:
An 81-year-old man was admitted to the hospital with a fever and loss of appetite. After treatment with piperacillin sodium (PIPC), the patient exhibited thrombocytopenia, hemorrhagic colitis, and drug-induced skin eruption. On the fifth day after PIPC induction, he further experienced neurological abnormalities, such as disorientation and confusion, renal dysfunction, and microangiopathic hemolytic anemia (MAHA). The patient was diagnosed with thrombotic thrombocytopenic purpura (TTP) on the basis of thrombocytopenia, MAHA, renal dysfunction, fever, and neurological abnormalities. Infusion of fresh-frozen plasma was initiated for treatment. His condition improved markedly after this treatment. It is rare for TTP to be accompanied with hemorrhagic colitis and skin eruption. These symptoms were induced by PIPC and were successfully treated with plasma infusion.
Insights
Piperacillin-induced thrombotic thrombocytopenic purpura (TTP) is rare, presenting with neurological issues, kidney dysfunction, and anemia. This case highlights TTP with unusual hemorrhagic colitis and skin eruption, successfully treated with plasma infusion.
Area of Science:
- Internal Medicine
- Pharmacology
- Hematology
Background:
- Antibiotic-associated adverse events can manifest with diverse clinical presentations.
- Piperacillin sodium (PIPC) is a commonly used antibiotic with a known side effect profile.
- Thrombotic thrombocytopenic purpura (TTP) is a rare but serious thrombotic microangiopathy.
Observation:
- An 81-year-old male developed fever and loss of appetite, followed by thrombocytopenia, hemorrhagic colitis, and skin eruption after PIPC treatment.
- The patient subsequently experienced neurological abnormalities, renal dysfunction, and microangiopathic hemolytic anemia (MAHA).
- These clinical features led to a diagnosis of TTP.
Findings:
- The patient's symptoms, including hemorrhagic colitis and skin eruption, were attributed to PIPC-induced TTP.
- Treatment with fresh-frozen plasma infusion resulted in significant clinical improvement.
- This case underscores the rare association of TTP with hemorrhagic colitis and skin eruption.
Implications:
- Physicians should consider TTP in patients presenting with unexplained thrombocytopenia, MAHA, renal, and neurological dysfunction, especially after antibiotic administration.
- Early recognition and prompt plasma infusion are crucial for managing TTP and improving patient outcomes.
- The unusual presentation emphasizes the need for vigilance regarding rare drug-induced adverse events.