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Severe Thrombocytopenia in a Patient with COVID-19

Eliel Nham1, Jae Hoon Ko1, Byeong Ho Jeong2

  • 1Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Infection & Chemotherapy
|April 29, 2020
PubMed

Insights

This case study highlights a severe drop in platelet count in a COVID-19 patient treated with multiple drugs. Discontinuing ceftriaxone, levofloxacin, and lopinavir/ritonavir led to platelet recovery, suggesting potential drug-induced thrombocytopenia.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Hematology

Background:

  • The global spread of Coronavirus disease 2019 (COVID-19) necessitates urgent treatment strategies.
  • Empirical antibacterial and antiviral therapies are commonly used due to incomplete understanding of COVID-19's clinical features and potential co-infections.
  • Polypharmacy is frequently employed in managing severe COVID-19 cases.

Observation:

  • A patient with COVID-19 developed severe thrombocytopenia, characterized by epistaxis and petechiae.
  • The patient was concurrently treated with ceftriaxone, levofloxacin, and lopinavir/ritonavir.
  • Platelet count dropped critically to 2,000/mm³.

Findings:

  • Discontinuation of the three suspect medications (ceftriaxone, levofloxacin, lopinavir/ritonavir) resulted in the recovery of the patient's platelet count.
  • This suggests a potential link between the combination of these drugs and the observed severe thrombocytopenia.

Implications:

  • While empirical treatment is crucial for emerging infectious diseases like COVID-19, careful consideration of potential adverse drug effects is essential.
  • This case underscores the importance of monitoring for drug-induced thrombocytopenia in patients receiving multiple medications.
  • Further investigation into the safety profile of combined antibiotic and antiviral therapies in COVID-19 patients is warranted.

Keywords:
COVID-19CeftriaxoneLevofloxacinLopinavir/ritonavirThrombocytopenia

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